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

  • Fabian Grass
  • Basile Pache
  • Fabio Butti
  • Josep Solà
  • Dieter Hahnloser
  • Nicolas DemartinesEmail author
  • Martin Hübner
ORIGINAL ARTICLE
  • 47 Downloads

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.

Keywords

Loop ileostomy Fluid management Weight gain Postoperative ileus Complications 

Abbreviations

ERAS

enhanced recovery after surgery

Notes

Authors’ contribution

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.

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).

Supplementary material

423_2018_1744_Fig3_ESM.png (346 kb)
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)

423_2018_1744_MOESM1_ESM.tiff (32.1 mb)
High Resolution Image (TIFF 32874 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Visceral SurgeryLausanne University Hospital CHUVLausanneSwitzerland
  2. 2.Centre Suisse d’Electronique et de Microtechnique (CSEM)NeuchâtelSwitzerland

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