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Langenbeck's Archives of Surgery

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01-02-2019 | Ileus | ORIGINAL ARTICLE

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

Authors: Fabian Grass, Basile Pache, Fabio Butti, Josep Solà, Dieter Hahnloser, Nicolas Demartines, Martin Hübner

Published in: Langenbeck's Archives of Surgery | Issue 1/2019

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.

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Title: Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure
Authors: Fabian Grass
Basile Pache
Fabio Butti
Josep Solà
Dieter Hahnloser
Nicolas Demartines
Martin Hübner
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Keywords: Ileus
Ileostomy
Published in: Langenbeck's Archives of Surgery / Issue 1/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-018-1744-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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