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

• DOI: 10.1007/s00423-018-1744-4
• Publication Date: 2019-01-03T12:56:47Z
• Authors: Fabian Grass; Basile Pache; Fabio Butti; Josep Solà; Dieter Hahnloser; Nicolas Demartines; Martin Hübner
• Keywords: Adult; Male; Intraoperative Care; Adult; Aged; Cohort Studies; Female; Fluid Therapy; Humans; Ileostomy/adverse effects; Ileus/etiology; Ileus/prevention & control; Intraoperative Care; Length of Stay; Male; Middle Aged; Postoperative Complications/etiology; Postoperative Complications/prevention & control; ROC Curve; Rectal Diseases/surgery; Weight Gain; Complications; Fluid management; Loop ileostomy; Postoperative ileus; Weight gain; Ileostomy; Length of Stay; Middle Aged; Weight Gain; Cohort Studies; 03 medical and health sciences; Ileus; Postoperative Complications; Rectal Diseases; 0302 clinical medicine; ROC Curve; Fluid Therapy; Humans; Female; Aged

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.