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

Omar Vergara-Fernández, Mario Trejo-Avila, Oscar Santes, Danilo Solórzano-Vicuña, Noel Salgado-Nesme, Omar Vergara-Fernández, Mario Trejo-Avila, Oscar Santes, Danilo Solórzano-Vicuña, Noel Salgado-Nesme

Abstract

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.

Keywords: Colorectal surgery; Dehydration; High-output ileostomy; Loop ileostomy; Loop ileostomy complications.

Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

References

    1. Sharma A, Deeb AP, Rickles AS, Iannuzzi JC, Monson JR, Fleming FJ. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis. 2013;15:458–462.
    1. Alberts JC, Parvaiz A, Moran BJ. Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis. 2003;5:478–482.
    1. Lightner AL, Pemberton JH. The Role of Temporary Fecal Diversion. Clin Colon Rectal Surg. 2017;30:178–183.
    1. Hayden DM, Pinzon MC, Francescatti AB, Edquist SC, Malczewski MR, Jolley JM, Brand MI, Saclarides TJ. Hospital readmission for fluid and electrolyte abnormalities following ileostomy construction: preventable or unpredictable? J Gastrointest Surg. 2013;17:298–303.
    1. Bhangu A, Nepogodiev D, Futaba K West Midlands Research Collaborative. Systematic review and meta-analysis of the incidence of incisional hernia at the site of stoma closure. World J Surg. 2012;36:973–983.
    1. Justiniano CF, Temple LK, Swanger AA, Xu Z, Speranza JR, Cellini C, Salloum RM, Fleming FJ. Readmissions With Dehydration After Ileostomy Creation: Rethinking Risk Factors. Dis Colon Rectum. 2018;61:1297–1305.
    1. Shaffer VO, Owi T, Kumarusamy MA, Sullivan PS, Srinivasan JK, Maithel SK, Staley CA, Sweeney JF, Esper G. Decreasing Hospital Readmission in Ileostomy Patients: Results of Novel Pilot Program. J Am Coll Surg. 2017;224:425–430.
    1. Messaris E, Sehgal R, Deiling S, Koltun WA, Stewart D, McKenna K, Poritz LS. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum. 2012;55:175–180.
    1. Fish DR, Mancuso CA, Garcia-Aguilar JE, Lee SW, Nash GM, Sonoda T, Charlson ME, Temple LK. Readmission After Ileostomy Creation: Retrospective Review of a Common and Significant Event. Ann Surg. 2017;265:379–387.
    1. Baker ML, Williams RN, Nightingale JM. Causes and management of a high-output stoma. Colorectal Dis. 2011;13:191–197.
    1. Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR. Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum. 2013;56:974–979.
    1. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–1251.
    1. Hanna MH, Vinci A, Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary? Langenbecks Arch Surg. 2015;400:145–152.
    1. Man VC, Choi HK, Law WL, Foo DC. Morbidities after closure of ileostomy: analysis of risk factors. Int J Colorectal Dis. 2016;31:51–57.
    1. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–899.
    1. Gu WL, Wu SW. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies. World J Surg Oncol. 2015;13:9.
    1. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010;251:807–818.
    1. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355–358.
    1. Nagle D, Pare T, Keenan E, Marcet K, Tizio S, Poylin V. Ileostomy pathway virtually eliminates readmissions for dehydration in new ostomates. Dis Colon Rectum. 2012;55:1266–1272.
    1. Bliss LA, Maguire LH, Chau Z, Yang CJ, Nagle DA, Chan AT, Tseng JF. Readmission After Resections of the Colon and Rectum: Predictors of a Costly and Common Outcome. Dis Colon Rectum. 2015;58:1164–1173.
    1. Chen SY, Stem M, Cerullo M, Canner JK, Gearhart SL, Safar B, Fang SH, Efron JE. Predicting the Risk of Readmission From Dehydration After Ileostomy Formation: The Dehydration Readmission After Ileostomy Prediction Score. Dis Colon Rectum. 2018;61:1410–1417.
    1. King RF, Norton T, Hill GL. A double-blind crossover study of the effect of loperamide hydrochloride and codeine phosphate on ileostomy output. Aust N Z J Surg. 1982;52:121–124.
    1. Gessler B, Haglind E, Angenete E. Loop ileostomies in colorectal cancer patients--morbidity and risk factors for nonreversal. J Surg Res. 2012;178:708–714.
    1. D'Haeninck A, Wolthuis AM, Penninckx F, D'Hondt M, D'Hoore A. Morbidity after closure of a defunctioning loop ileostomy. Acta Chir Belg. 2011;111:136–141.
    1. Mala T, Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis. 2008;10:785–788.
    1. Chun LJ, Haigh PI, Tam MS, Abbas MA. Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum. 2012;55:167–174.
    1. Hallböök O, Matthiessen P, Leinsköld T, Nyström PO, Sjödahl R. Safety of the temporary loop ileostomy. Colorectal Dis. 2002;4:361–364.
    1. Vergara-Fernandez O, Trejo-Avila M, Salgado-Nesme N. Multivariate analysis of risk factors for complications after loop ileostomy closure. Cir Cir. 2019;87:337–346.

Source: PubMed

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