Preoperative High Agatston Score in Aorta Leads to Postoperative High-Output Ileostomy

Ileostomy is often constructed during rectal cancer resection to prevent anastomotic leakage. Among the complications related to ileostomy, high-output stoma (HOS) can induce dehydration, posing the risk of renal impairment. This study aimed to investigate the utility of arteriosclerosis as a novel risk factor for the occurrence of HOS by quantifying arteriosclerosis using the Agatston score and examining its association with HOS.

A retrospective cohort study was conducted on 115 rectal cancer patients who had temporary ileostomies constructed. The Agatston score was used to quantify aortic calcification on preoperative computed tomography images using the SYNAPSE VINCENT system.

HOS occurred in 24.1% of all patients. Using receiver operating characteristic analysis, a cutoff value was determined, and patients were divided into two groups. In the high Agatston score group (n = 39), there was a significantly higher incidence of HOS (P = 0.01), and this group also had a higher prevalence of diabetes, higher American Society of Anesthesiologists - physical status classification system score, higher serum creatinine levels, higher proportion of proton pump inhibitors use, and were of older age. Multivariate analysis identified high neutrophil-to-lymphocyte ratio and high Agatston score as independent risk factors for the occurrence of HOS.

A high Agatston score is associated with the HOS occurrence. It may be more preferable to avoid ileostomy in patients with severe arteriosclerosis.