Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection

Orthostatic hypotension (OH) and intolerance (OI) are common findings in the early postoperative period after major surgery and may delay early mobilization. The mechanism of impaired orthostatic competence and OI symptoms is not fully understood, and specific data after colorectal surgery with well-defined perioperative care regimens and mobilization protocols are lacking. The aim of this study was to investigate the prevalence, possible risk factors and the impact of OI in patients undergoing elective minimal invasive colorectal cancer resection.

A prospective single-centre study with an optimal enhanced recovery program and multimodal analgesic treatment. OI and OH were evaluated using a well-defined mobilization protocol preoperatively and 6 hour and 24 hour postoperatively.

A total of 100 patients were included in the data analysis. The overall median length of stay was 3 days (1-38). OI was observed in 53% of the patients 6 hour postoperatively and in 24% at 24 hour. OI at 6 hour postoperatively was associated with younger age, lower BMI, and female gender. At 24 hour postoperatively, female gender and ASA class >1 was associated with OI. Opioid consumption and intravenous fluid during the first 24 hour was not associated with OI. Postoperative complications were equally observed between patients with and without OI. Although not statistically significant, patients with OI at 24 hour postoperatively had prolonged LOS (mean 4.0 vs 7.5 days, P = 0.069) compared with patients without OI.

Postoperative orthostatic intolerance is a common problem during the first 24 hour following laparoscopic colorectal resection and may be followed by delayed recovery.