Abstract
Background: Recently formed ileostomies may produce an average of 1,200 ml of watery stool per day, while an established ileostomy output varies between 600–800 ml per day. The reported incidence of renal impartment in patients with ileostomy is 8–20%, which could be caused by dehydration (up to 50%) or high output stoma (up to 40%). There is a lack of evidence if an ileostomy could influence perioperative fluid management and/or surgical outcomes.Methods: Subjects aged ≥18 years old with an established ileostomy scheduled to undergo an elective non-ileostomy-related major abdominal surgery under general anesthesia lasting more than 2 h and requiring hospitalization were included in the study. The primary outcome was to assess the incidence of perioperative complications within 30 days after surgery.Results: A total of 552 potential subjects who underwent non-ileostomy-related abdominal surgery were screened, but only 12 were included in the statistical analysis. In our study cohort, 66.7% of the subjects were men and the median age was 56 years old (interquartile range [IQR] 48-59). The median time from the creation of ileostomy to the qualifying surgery was 17.7 months (IQR: 8.3, 32.6). The most prevalent comorbidities in the study group were psychiatric disorders (58.3%), hypertension (50%), and cardiovascular disease (41.7%). The most predominant surgical approach was open (8 [67%]). The median surgical and anesthesia length was 3.4 h (IQR: 2.5, 5.7) and 4 h (IQR: 3, 6.5), respectively. The median post-anesthesia care unit (PACU) stay was 2 h (IQR:0.9, 3.1), while the median length of hospital stay (LOS) was 5.6 days (IQR: 4.1, 10.6). The overall incidence of postoperative complications was 50% (n = 6). Two subjects (16.7%) had a moderate surgical wound infection, and two subjects (16.7%) experienced a mild surgical wound infection. In addition, one subject (7.6%) developed a major postoperative complication with atrial fibrillation in conjunction with moderate hemorrhage.Conclusions: Our findings suggest that the presence of a well-established ileostomy might not represent a relevant risk factor for significant perioperative complications related to fluid management or hospital readmission. However, the presence of peristomal skin complications could trigger a higher incidence of surgical wound infections.
Highlights
Temporary or permanent diverting loop ileostomies are commonly created to protect a distal anastomosis with a high risk of anastomotic leakage, resulting in reduced morbidity and mortality [1]
Even though the median time elapsed from the ileostomy creation and the non-ileostomy surgery in our study was 17.7 months (IQR: 8.3, 32.6), we found no evidence of postoperative ostomy-related complications (e.g., High-output stoma (HOS)), electrolyte imbalance, and impaired renal function in our patient setting
The perioperative management of patients with established ileostomies undergoing major abdominal surgeries might be challenging to anesthesia care providers and surgeons
Summary
Temporary or permanent diverting loop ileostomies are commonly created to protect a distal anastomosis with a high risk of anastomotic leakage, resulting in reduced morbidity and mortality [1]. Formed ileostomies may produce an average of 1,200 ml of watery stool per day [2], while an established ileostomy (longer than 1 year) output varies between 600 and 800 ml per day [3, 4]. Excessive fluid loss through the stoma and the inability of the small bowel to preserve sodium, chloride, and bicarbonate may result in life-threatening complications such as acute dehydration, electrolyte imbalance, and acid-base disorder [5,6,7,8]. Formed ileostomies may produce an average of 1,200 ml of watery stool per day, while an established ileostomy output varies between 600–800 ml per day. The reported incidence of renal impartment in patients with ileostomy is 8–20%, which could be caused by dehydration (up to 50%) or high output stoma (up to 40%). There is a lack of evidence if an ileostomy could influence perioperative fluid management and/or surgical outcomes
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