Predictors of dehydration and acute renal failure in patients with diverting loop ileostomy creation after colorectal surgery

作     者：Omar Vergara-Fernández Mario Trejo-Avila Oscar Santes Danilo Solórzano-Vicu?a Noel Salgado-Nesme 

作者机构：Department of Colorectal Surgery Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2019年第7卷第14期

页      面：1805-1813页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Loop ileostomy High-output ileostomy Loop ileostomy complications Dehydration Colorectal surgery 

摘      要：BACKGROUND Despite the potential benefits of fecal diversion after low pelvic anastomosis in colorectal surgery, diverting loop ileostomy construction is related to significant rates of complications. AIM To determine potential predictors of high output related complications in patients with diverting loop ileostomy creation after colorectal surgery. METHODS Patients who underwent open and laparoscopic colorectal surgery requiring a diverting loop ileostomy from January 2010 to March 2018 were retrospectively analyzed. We included patients older than 18 years, who underwent colorectal surgery with primary low pelvic anastomosis, and with the creation of a diverting loop ileostomy, at elective or emergency settings for the treatment of benign or malignant conditions. Univariate and multivariate logistic regression analysis was used to determine the effect of the potential predictors on the rate of high output related complications. The high output related complications were dehydration and acute renal failure that required visits to the emergency department and hospitalizations. RESULTS Of the 102 patients included in the study, 23.5%(n = 24) suffered high output related complications. In this group of patients at least one visit to the emergency department (mean 1.6), and at least one readmission to the hospital was needed. The factors associated with high-output ileostomy, in the univariate analysis, were: urgent surgical intervention (OR = 2.6;P = 0.047), the development of postoperative complications (OR = 3;P = 0.024), have ulcerative colitis (OR = 4.8;P = 0.017), use of steroids (OR = 4.3;P = 0.010), mean output at discharge greater than 1000 mL/24 h (OR = 3.2;P = 0.016), and use of loperamide at discharge (OR = 2.8;P = 0.032). Multivariate logistic regression analysis identified two independent risk factors for high output related complications: ulcerative colitis [OR = 7.6 (95%CI: 1.81-31.95);P = 0.006], and ileostomy output at discharge ≥ 1000 mL/24 h [OR = 3.3 (1.18-9.37);P = 0.023]. CONCLUSION In our study, patients with ulcerative colitis and those with an ileostomy output above 1000 mL/24 h at discharge, were at increased risk of high output related complications.