Abstract
Purpose
The present study aimed to analyze the impact of perioperative fluid management on postoperative ileus (POI) after loop ileostomy closure.
Methods
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.
Results
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.
Conclusions
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.
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Abbreviations
- ERAS:
-
enhanced recovery after surgery
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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.
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The authors declare that they have no conflict of interest.
Ethical approval
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.
Informed consent
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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ESM 1
Online appendix ROC curves. a. IV fluid administration at POD 0. b. Weight gain at POD 2. ROC curves for a) total IV fluid administration at POD 0 and for b) weight gain at POD 2 and POI (n=33) for loop ileostomy closure. AUC – area under the curve, Thd: threshold (mL and kg, respectively) (PNG 345 kb)
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Grass, F., Pache, B., Butti, F. et al. Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure. Langenbecks Arch Surg 404, 39–43 (2019). https://doi.org/10.1007/s00423-018-1744-4
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DOI: https://doi.org/10.1007/s00423-018-1744-4