Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2019; 7(14): 1805-1813
Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1805
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, Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City 14080, Mexico
Author contributions: Omar Vergara-Fernández, and Mario Trejo-Avila designed this work, collected and interpreted the data, and drafted the manuscript. Mario Trejo-Avila performed statistical analyses. Oscar Santes, Danilo Solórzano-Vicuña, Noel Salgado-Nesme contributed to study concept, critically revised the manuscript, and performed overall supervision. All authors contributed to the final approval of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of the hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors deny any conflict of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mario Trejo-Avila, MD, Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Vasco de Quiroga, 15, Sección XVI, Tlalpan 14080, Mexico City, Mexico. mario.trejo.avila@gmail.com
Telephone: +52-15-4870900-2142
Received: April 6, 2019
Peer-review started: April 8, 2019
First decision: May 31, 2019
Revised: June 17, 2019
Accepted: June 26, 2019
Article in press: June 27, 2019
Published online: July 26, 2019
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: Loop ileostomy, High-output ileostomy, Loop ileostomy complications, Dehydration, Colorectal surgery

Core tip: In this retrospective study involving 102 patients who underwent colorectal surgery resections with primary low pelvic anastomosis and with the creation of a diverting loop ileostomy for the treatment of benign and malignant conditions, we evaluated the risk factors for high output related complications. The high output related complications were dehydration and acute renal failure that required visits to the emergency department and hospitalizations. We found that patients with ulcerative colitis and those with an ileostomy output above 1000 mL/24 h at the moment of discharge, were at increased risk of high output related complications.