Greenberg Anya L, Kelly Yvonne M, McKay Rachel E, Varma Madhulika G, Sarin Ankit
School of Medicine, University of California, San Francisco, 513 Parnassus Ave #S-245, San Francisco, CA, 94143, USA.
Department of Surgery, University of California, San Francisco, 513 Parnassus Ave #S-321, San Francisco, CA, 94143, USA.
Perioper Med (Lond). 2021 Dec 13;10(1):55. doi: 10.1186/s13741-021-00226-z.
Postoperative ileus (POI) is associated with increased patient discomfort, length of stay (LOS), and healthcare cost. There is a paucity of literature examining POI in patients who have an ileostomy formed at the time of surgery. We aimed to identify risk factors for and outcomes associated with POI following ileostomy formation.
We included 261 consecutive non-emergent cases that included formation of an ileostomy by a board-certified colorectal surgeon at our institution from July 1, 2015, to June 30, 2020. Demographic, clinical, and intraoperative factors associated with increased odds of POI were evaluated. Post-procedure LOS, hospitalization cost, and re-admissions between patients with and without POI were compared.
Out of 261 cases, 85 (32.6%) were associated with POI. Patients with POI had significantly higher body mass index (BMI) than those without POI (26.6 kg/m vs. 24.8kg/m; p = 0.01). Intraoperatively, patients with POI had significantly longer procedure duration than those without POI (313 min vs. 279 min; p = 0.02). Patients with POI had a significantly higher net fluid balance at postoperative day (POD) 2 than those without POI (+ 2.65 L vs. + 1.80 L; p = 0.004), with POD2 fluid balance greater than + 807 mL (determined as the maximum Youden index for sensitivity over 80%) associated with a higher rate of POI (p = 0.006). This difference remained significant when adjusted for age, gender, BMI, pre-operative opioid use, procedure duration, and operative approach (p = 0.01). Patients with POI had significantly longer LOS (11.40 days vs. 5.12 days; p < 0.001) and direct cost of hospitalization ($38K vs. $22K; p < 0.001).
Minimizing fluid overload, particularly in the first 48 h after surgery, may be a strategy to reduce POI in patients undergoing ileostomy formation, and thus decrease postoperative LOS and hospitalization cost. Fluid restriction, diuresis, and changes in diet advancement or early stoma intubation should be considered measures that may improve outcomes and should be studied more intensively.
术后肠梗阻（POI）与患者不适增加、住院时间（LOS）延长及医疗费用增加相关。目前关于手术时行回肠造口术患者的POI研究文献较少。我们旨在确定回肠造口术后POI的危险因素及相关结局。
我们纳入了2015年7月1日至2020年6月30日在我院由一名经委员会认证的结直肠外科医生连续实施回肠造口术的261例非急诊病例。评估了与POI发生几率增加相关的人口统计学、临床和术中因素。比较了发生POI和未发生POI患者的术后住院时间、住院费用及再入院情况。
261例病例中，85例（32.6%）发生POI。发生POI的患者体重指数（BMI）显著高于未发生POI的患者（26.6kg/m²对24.8kg/m²；p = 0.01）。术中，发生POI的患者手术时间显著长于未发生POI的患者（313分钟对279分钟；p = 0.02）。发生POI的患者术后第2天的净液体平衡显著高于未发生POI的患者（+2.65L对+1.80L；p = 0.004），术后第2天液体平衡大于+807mL（确定为敏感度超过80%时的最大约登指数）与POI发生率较高相关（p = 0.006）。在对年龄、性别、BMI、术前阿片类药物使用、手术时间和手术方式进行校正后，这种差异仍然显著（p = 0.01）。发生POI的患者住院时间显著延长（11.40天对5.12天；p < 0.001），住院直接费用更高（38000美元对22000美元；p < 0.001）。
尽量减少液体超负荷，尤其是在术后头48小时内，可能是降低行回肠造口术患者POI的一种策略，从而缩短术后住院时间并降低住院费用。液体限制、利尿以及饮食推进或早期造口插管的改变应被视为可能改善结局的措施，并且应进行更深入的研究。
