Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure
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The present study aimed to analyze the impact of perioperative fluid management on postoperative ileus (POI) after loop ileostomy closure.
Consecutive loop ileostomy closures over a 6-year period (May 2011–May 2017) were included. Main outcomes were POI, defined as time to first stool beyond POD 3, and postoperative complications of any grade. Critical fluid management–related thresholds including postoperative weight gain were identified through receiver operator characteristics (ROC) analysis and tested in a multivariable analysis.
Of 238 included patients, 33 (14%) presented with POI; overall complications occurred in 91 patients (38%). 1.7 L IV fluids at postoperative day (POD) 0 was determined a critical threshold for POI (area under ROC curve (AUROC), 0.64), yielding a negative predictive value (NPV) of 93%. Further, a critical cutoff for a postoperative weight gain of 1.2 kg at POD 2 was identified (AUROC, 0.65; NPV, 95%). Multivariable analysis confirmed POD 0 fluids of > 1.7 L (OR, 4.7; 95% CI, 1.4–15.3; p = 0.01) and POD 2 weight gain of > 1.2 kg (OR, 3.1; 95% CI, 1–9.4; p = 0.046) as independent predictors for POI.
Perioperative fluid administration of > 1.7 L and POD 2 weight gain of > 1.2 kg represent critical thresholds for POI after loop ileostomy closure.
KeywordsLoop ileostomy Fluid management Weight gain Postoperative ileus Complications
enhanced recovery after surgery
FG, BP, JS, and MH: study conception and design; FG, BP, FB, and JS: acquisition of data; FG, BP, FB, DH, ND, and MH: analysis and interpretation of data; FG, BP, FB, DH, ND, and MH: drafting of manuscript; FG, BP, FB, JS, DH, ND, and MH: critical revision of manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This study was conducted as an institutional quality improvement project. Therefore, no informed consent was needed, after approval of the Institutional Review Board (Commission cantonale d’éthique de la recherche sur l’être humain CER-VD # 2017-01971).
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