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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

There is a lack of articles analyzing the risk of complications related to high output complications focusing only in this population (patients with diverting loop ileostomies).

Research objectives

Our main purpose was to determine potential predictors of high output related complications in patients with diverting loop ileostomy creation after colorectal surgery.

Research methods

Patients who underwent open and laparoscopic colorectal surgery requiring a diverting loop ileostomy from January 2010 to March 2018 were retrospectively analyzed. Univariate and multivariate logistic regression analysis was used to determine the effect of the potential predictors on the rate of high output related complications.

Research 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 (P = 0.047), the development of postoperative complications (P = 0.024), ulcerative colitis (P = 0.017), use of steroids (P = 0.010), mean output at discharge greater than 1000 mL/24 h (P = 0.016), and use of loperamide (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].

Research conclusions

Patients with ulcerative colitis and those with an ileostomy output above 1000 mL/24 h at discharge, were at increased risk of high output complications.

Research perspectives

This article reflects that diverting loop ileostomy has become a surgical technique commonly employed after open and laparoscopic colorectal resections with low pelvic anastomosis. Despite the frequency of the employment of this technique, there is a lack of articles analyzing the risk of readmission focusing only in this population. Our results support that not only patients with terminal ileostomies, but also patients with diverting loop ileostomy represent a high risk group for presenting to the emergency department with dehydration and acute renal failure.