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Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

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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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Authors and Affiliations

  1. Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland

    Fabian Grass, Basile Pache, Fabio Butti, Dieter Hahnloser, Nicolas Demartines & Martin Hübner

  2. Centre Suisse d’Electronique et de Microtechnique (CSEM), Neuchâtel, Switzerland

    Josep Solà

Authors
  1. Fabian Grass
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  2. Basile Pache
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  3. Fabio Butti
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  4. Josep Solà
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  5. Dieter Hahnloser
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  6. Nicolas Demartines
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  7. Martin Hübner
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Contributions

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.

Corresponding author

Correspondence to Nicolas Demartines.

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Conflict of interest

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).

Electronic supplementary material

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

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