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

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Fluid Management

Background:

• Postoperative ileus (POI) is a common complication following abdominal surgery, particularly after loop ileostomy closure.
• Optimizing perioperative fluid management is crucial for patient recovery and reducing surgical morbidity.

Purpose of the Study:

• To investigate the impact of perioperative fluid administration and postoperative weight changes on the incidence of POI.
• To identify critical fluid management thresholds associated with POI after loop ileostomy closure.

Main Methods:

• A retrospective analysis of consecutive loop ileostomy closures performed between May 2011 and May 2017.
• Receiver operator characteristics (ROC) analysis was used to identify critical fluid thresholds.
• Multivariable analysis confirmed independent predictors of POI.

Main Results:

• Of 238 patients, 14% developed POI. Postoperative Day 0 fluid administration exceeding 1.7 L (OR, 4.7) and Postoperative Day 2 weight gain over 1.2 kg (OR, 3.1) were identified as independent predictors of POI.
• A fluid threshold of 1.7 L on POD 0 had a Negative Predictive Value (NPV) of 93% for POI.
• A weight gain threshold of 1.2 kg on POD 2 had an NPV of 95% for POI.

Conclusions:

• Perioperative fluid administration exceeding 1.7 L on POD 0 and a weight gain greater than 1.2 kg on POD 2 are critical thresholds predicting POI.
• These findings highlight the importance of vigilant fluid management to prevent POI after loop ileostomy closure.