Analysis of the perioperative factors influencing the occurrence of prolonged postoperative ileus in patients with Crohn′s disease
10.3760/cma.j.cn101480-20210603-00042
- VernacularTitle:克罗恩病患者发生延迟性术后肠麻痹的围手术期影响因素分析
- Author:
Yibo WANG
1
;
Zhen ZHANG
;
Zhenyu YUAN
;
Jianfeng GONG
;
Ming DUAN
;
Yi LI
;
Qing JI
Author Information
1. 南京大学医学院附属金陵医院（解放军东部战区总医院）麻醉科，南京 210002
- Publication Type:Journal Article
- Keywords:
Crohn′s disease;
Prolonged postoperative ileus;
Risk factors;
Perioperation;
Intraoperative in-out balance per body weight;
Surgery duration
- From:
Chinese Journal of Inflammatory Bowel Diseases
2022;06(1):42-49
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the perioperative factors which influence the occurrence of prolonged postoperative ileus (PPOI) in patients with Crohn′s disease (CD) .Methods:A retrospective case-control study was conducted. Clinical data of CD patients who underwent partial intestinal resection at Jinling Hospital of Medical School of Nanjing University from June 2019 to January 2021 were analyzed retrospectively. The patients were divided into PPOI group and non-PPOI group according to whether the PPOI happened or not. The differences in perioperative indexes between PPOI and non-PPOI groups were assessed by univariate analysis. Spearman rank correlation test was used to exclude variables with strong correlations. The receiver operating characteristic (ROC) curve was performed to determine the cut-off values of the variables with P<0.05 in univariate analysis and clinical significance, and the variables were converted into binary qualitative data. And then the data were analyzed by multivariate Logistic regression to determine the independent risk factors of PPOI. Results:A total of 314 patients were included, including 202 males and 112 females with the age of (39 ± 14) years old. Eighty-nine (28.3%) patients with PPOI were set as PPOI group, and 225 (71.7%) patients without PPOI were set as non-PPOI group. Compared with non-PPOI group, patients in PPOI group had longer surgery duration [128 (99, 166) min vs. 110 (85, 141) min, P = 0.006], more total opioids [2.9 (2.4, 3.3) MME/kg vs. 2.7 (2.4, 3.1) MME/kg, P = 0.011, MME: morphine milligram equivalent], more intraoperative infusion volume ( P = 0.009), more crystal solution volume ( P = 0.007), higher intraoperative in-out balance per body weight (IOB/BW) [18.8 (14.1, 25.5) ml/kg vs. 16.4 (12.5, 20.7) ml/kg, P = 0.005], lower minimum level of albumin within 3 days after surgery ( P = 0.019), higher maximum change of albumin level after surgery ( P = 0.024), lower minimum concentration of serum potassium within 3 days after surgery ( P = 0.007), and more infusion supplement on the first day after surgery ( P<0.001), and longer postoperative hospital stay ( P<0.001). In the correlation analysis, there were strong correlations between intraoperative infusion volume and IOB/BW ( r = 0.689, P<0.001), and intraoperative infusion volume and crystal fluid volume ( r = 0.986, P<0.001) respectively. Therefore, intraoperative infusion volume and crystal fluid volume were excluded from the multivariate analysis. The cut-off value of the surgery duration was 123.5 min by ROC curve, the total opioids was 2.84 MME/kg, IOB/BW was 21.08 ml/kg, the minimum level of albumin and the minimum concentration of serum potassium within 3 days after surgery were 29.15 g/L and 3.75 mmol/L respectively, the maximum change of albumin level after surgery was 7.25 g/L, and the fluid supplement on the first day after surgery was 2751.5 ml. In multivariate Logistic regression analysis, surgery duration ≥ 123.5 min ( OR = 2.162, 95% CI: 1.260-3.710, P = 0.005), IOB/BW≥21.08 ml/kg ( OR = 3.184, 95% CI: 1.817-5.581, P<0.001), maximum change of albumin level ≥7.25 g/L after surgery ( OR = 1.948, 95% CI: 1.110-3.419, P = 0.02) and fluid supplement ≥2751.5 ml on the first day after surgery ( OR = 2.845, 95% CI: 1.630-4.966, P<0.001) were the independent risk factors for PPOI. Conclusions:CD patients who have the factors of long surgery duration, high IOB/BW, big change of albumin level after surgery and much fluid supplement on the first day after surgery are prone to PPOI. Therefore, controlling IOB/BW and fluid supplement on the first day after surgery are important measures to reduce the incidence of PPOI.
