Restricting Intraoperative Fluid Volume Allows Earlier Return of Bowel Function After Colon and Rectal Surgery

Nkechinye Omesiete, Carolina Martinez, V. Pandit, Yadira Villalvazo, Hunter Jecius, Eli Thompson, Meleesa Norcera, Valentine N Nfonsam

Research output: Contribution to journalArticle

Abstract

Background: Return of bowel function (ROBF) after abdominal surgery is an important determinant of patient outcomes. The role of intraoperative fluids (IOFs) in colon surgery remains unclear. The aim of this study was to assess the impact of IOF on ROBF in patients undergoing colon surgery. We hypothesized that minimizing IOFs allows earlier ROBF. Methods: A 2-year (2016-2017) retrospective analysis of all patients undergoing elective colon resection was performed at our tertiary hospital using a protocol limiting IOF and postoperative narcotics. Patients were divided into two groups: preprotocol (2016) and postprotocol (PoP) (2017). Patients were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication for procedure, and procedure type. The outcome measured was ROBF. Secondary outcome measures were complication rates and hospital length of stay. Results: A total of 360 patients were analyzed. After propensity matching, 90 patients (preprotocol: 45; PoP: 45) were included. The mean age was 62.2 ± 14.8 y, 43.3% male, and 44.4% of procedures were performed laparoscopically. There was no difference in demographics and comorbidities between groups. PoP patients received lower IOF (P = 0.036, 2016: 1198.8 ± 1096.5 mL, 2017: 2176.7 ± 1458.3 mL) and lower postoperative narcotics (P = 0.042). PoP patients had earlier ROBF 2[2-4], 4[3-5] (odds ratio: 1.18 [1.05-1.52], P = 0.04), shorter length of stay 3[2-5] d versus 5[4-7] (odds ratio: 1.11 [1.09-1.89], P = 0.043), and trended toward lower complication rates (P = 0.09). Conclusions: IOF volume independently impacts ROBF after colon surgery. Restricting IOF allows for earlier bowel function and shorter hospital stay. Further studies defining optimum fluid management impacting ROBF may help optimize patient care.

Original languageEnglish (US)
Pages (from-to)130-135
Number of pages6
JournalJournal of Surgical Research
Volume244
DOIs
StatePublished - Dec 1 2019

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Colon
Length of Stay
Narcotics
Comorbidity
Odds Ratio
Propensity Score
Anesthesiology
varespladib methyl
Tertiary Care Centers
Patient Care
Demography
Outcome Assessment (Health Care)

Keywords

  • Bowel function
  • Restrictive fluid

ASJC Scopus subject areas

  • Surgery

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Restricting Intraoperative Fluid Volume Allows Earlier Return of Bowel Function After Colon and Rectal Surgery. / Omesiete, Nkechinye; Martinez, Carolina; Pandit, V.; Villalvazo, Yadira; Jecius, Hunter; Thompson, Eli; Norcera, Meleesa; Nfonsam, Valentine N.

In: Journal of Surgical Research, Vol. 244, 01.12.2019, p. 130-135.

Research output: Contribution to journalArticle

Omesiete, Nkechinye ; Martinez, Carolina ; Pandit, V. ; Villalvazo, Yadira ; Jecius, Hunter ; Thompson, Eli ; Norcera, Meleesa ; Nfonsam, Valentine N. / Restricting Intraoperative Fluid Volume Allows Earlier Return of Bowel Function After Colon and Rectal Surgery. In: Journal of Surgical Research. 2019 ; Vol. 244. pp. 130-135.
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abstract = "Background: Return of bowel function (ROBF) after abdominal surgery is an important determinant of patient outcomes. The role of intraoperative fluids (IOFs) in colon surgery remains unclear. The aim of this study was to assess the impact of IOF on ROBF in patients undergoing colon surgery. We hypothesized that minimizing IOFs allows earlier ROBF. Methods: A 2-year (2016-2017) retrospective analysis of all patients undergoing elective colon resection was performed at our tertiary hospital using a protocol limiting IOF and postoperative narcotics. Patients were divided into two groups: preprotocol (2016) and postprotocol (PoP) (2017). Patients were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication for procedure, and procedure type. The outcome measured was ROBF. Secondary outcome measures were complication rates and hospital length of stay. Results: A total of 360 patients were analyzed. After propensity matching, 90 patients (preprotocol: 45; PoP: 45) were included. The mean age was 62.2 ± 14.8 y, 43.3{\%} male, and 44.4{\%} of procedures were performed laparoscopically. There was no difference in demographics and comorbidities between groups. PoP patients received lower IOF (P = 0.036, 2016: 1198.8 ± 1096.5 mL, 2017: 2176.7 ± 1458.3 mL) and lower postoperative narcotics (P = 0.042). PoP patients had earlier ROBF 2[2-4], 4[3-5] (odds ratio: 1.18 [1.05-1.52], P = 0.04), shorter length of stay 3[2-5] d versus 5[4-7] (odds ratio: 1.11 [1.09-1.89], P = 0.043), and trended toward lower complication rates (P = 0.09). Conclusions: IOF volume independently impacts ROBF after colon surgery. Restricting IOF allows for earlier bowel function and shorter hospital stay. Further studies defining optimum fluid management impacting ROBF may help optimize patient care.",
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AU - Omesiete, Nkechinye

AU - Martinez, Carolina

AU - Pandit, V.

AU - Villalvazo, Yadira

AU - Jecius, Hunter

AU - Thompson, Eli

AU - Norcera, Meleesa

AU - Nfonsam, Valentine N

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N2 - Background: Return of bowel function (ROBF) after abdominal surgery is an important determinant of patient outcomes. The role of intraoperative fluids (IOFs) in colon surgery remains unclear. The aim of this study was to assess the impact of IOF on ROBF in patients undergoing colon surgery. We hypothesized that minimizing IOFs allows earlier ROBF. Methods: A 2-year (2016-2017) retrospective analysis of all patients undergoing elective colon resection was performed at our tertiary hospital using a protocol limiting IOF and postoperative narcotics. Patients were divided into two groups: preprotocol (2016) and postprotocol (PoP) (2017). Patients were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication for procedure, and procedure type. The outcome measured was ROBF. Secondary outcome measures were complication rates and hospital length of stay. Results: A total of 360 patients were analyzed. After propensity matching, 90 patients (preprotocol: 45; PoP: 45) were included. The mean age was 62.2 ± 14.8 y, 43.3% male, and 44.4% of procedures were performed laparoscopically. There was no difference in demographics and comorbidities between groups. PoP patients received lower IOF (P = 0.036, 2016: 1198.8 ± 1096.5 mL, 2017: 2176.7 ± 1458.3 mL) and lower postoperative narcotics (P = 0.042). PoP patients had earlier ROBF 2[2-4], 4[3-5] (odds ratio: 1.18 [1.05-1.52], P = 0.04), shorter length of stay 3[2-5] d versus 5[4-7] (odds ratio: 1.11 [1.09-1.89], P = 0.043), and trended toward lower complication rates (P = 0.09). Conclusions: IOF volume independently impacts ROBF after colon surgery. Restricting IOF allows for earlier bowel function and shorter hospital stay. Further studies defining optimum fluid management impacting ROBF may help optimize patient care.

AB - Background: Return of bowel function (ROBF) after abdominal surgery is an important determinant of patient outcomes. The role of intraoperative fluids (IOFs) in colon surgery remains unclear. The aim of this study was to assess the impact of IOF on ROBF in patients undergoing colon surgery. We hypothesized that minimizing IOFs allows earlier ROBF. Methods: A 2-year (2016-2017) retrospective analysis of all patients undergoing elective colon resection was performed at our tertiary hospital using a protocol limiting IOF and postoperative narcotics. Patients were divided into two groups: preprotocol (2016) and postprotocol (PoP) (2017). Patients were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication for procedure, and procedure type. The outcome measured was ROBF. Secondary outcome measures were complication rates and hospital length of stay. Results: A total of 360 patients were analyzed. After propensity matching, 90 patients (preprotocol: 45; PoP: 45) were included. The mean age was 62.2 ± 14.8 y, 43.3% male, and 44.4% of procedures were performed laparoscopically. There was no difference in demographics and comorbidities between groups. PoP patients received lower IOF (P = 0.036, 2016: 1198.8 ± 1096.5 mL, 2017: 2176.7 ± 1458.3 mL) and lower postoperative narcotics (P = 0.042). PoP patients had earlier ROBF 2[2-4], 4[3-5] (odds ratio: 1.18 [1.05-1.52], P = 0.04), shorter length of stay 3[2-5] d versus 5[4-7] (odds ratio: 1.11 [1.09-1.89], P = 0.043), and trended toward lower complication rates (P = 0.09). Conclusions: IOF volume independently impacts ROBF after colon surgery. Restricting IOF allows for earlier bowel function and shorter hospital stay. Further studies defining optimum fluid management impacting ROBF may help optimize patient care.

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