Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Research Article Volume 4 Issue 1

Nutritional Factors Associated with Complications After Loop Ileostomy Reversal in Patients with Inflammatory Bowel Disease

Jordan A Munger, Tamar B Nobel, Alex Mui, David Chessin, Stephen Gorfine, Daniel Popowich and Joel Bauer*

Department of Surgery, Mount Sinai Hospital, New York, USA

*Corresponding Author: Joel Bauer, Professor of Surgery, Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, USA.

Received: November 11, 2020; Published: December 16, 2020

×

Abstract

Background: Ileostomy formation is often performed in an acute setting with increased nutritional demands - presumed nutritional recovery has occurred at time of reversal. There is a paucity of data evaluating the effect of nutritional status on serious complications following loop ileostomy reversal in patients with inflammatory bowel disease (IBD). While ileostomy reversal is often considered a routine procedure relatively free of complications, we chose to evaluate our group of patients with IBD having this procedure and explored if measures of nutritional compromise at the time of reversal were associated with post-operative complications.

Methods: We retrospectively reviewed 359 patients with IBD who underwent ileostomy reversal. Demographics, clinical characteristics, and laboratory values were compared between patients stratified by serious 30-day post-operative complications.

Results: The overall median time to reversal was 13.1 weeks, (IQR 11-16), and this was comparable between those with and without serious complications. The overall serious complication rate was 22/359 (6.1%). Patients with serious complications had lower median albumin at time of reversal (3.3 vs 3.8; p = 0.049), higher incidence of anemia (68.4% vs 37.5%, p = 0.013) and greater interval decrease in BMI from time of ileostomy creation to closure (-2.1 vs -0.6; p = 0.03). Multivariate modeling demonstrated that for each integer increase in albumin, the odds of serious complication decreased by 59% (OR 0.41, 95% CI 0.20-0.83).

Conclusions: IBD patients are at unique increased risk for nutritional compromise. Patients with malnutrition may be at increased risk of serious complications following ileostomy reversal. Surgeons should consider routine assessment of nutritional status prior to surgery and some patients may benefit from delay for optimization prior to ileostomy reversal.

Keywords: Inflammatory Bowel Disease; Ileostomy Reversal; Malnutrition; Postoperative Complications; Colorectal Surgery

×

References

  1. Hüser N., et al. “Systematic Review and Meta-Analysis of the Role of Defunctioning Stoma in Low Rectal Cancer Surgery”. Annuals of Surgery1 (2008): 52-60.
  2. Matthiessen P., et al. “Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection for cancer”. Color Disease 12 (2009): e82-87.
  3. Chow A., et al. “The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases". International Journal of Colorectal Disease 6 (2009): 711-723.
  4. Wexner SD., et al. “Loop ileostomy is a safe option for fecal diversion”. Diseases of the Colon and Rectum4 (1993): 349-354.
  5. Luglio G., et al. “Loop Ileostomy Reversal After Colon and Rectal Surgery”. Archives of Surgery10 (2011): 1191.
  6. D’Incà R., et al. “Functional and morphological changes in small bowel of Crohn’s disease patients. Influence of site of disease”. Digestive Diseases and Sciences6 (1995): 1388-1393.
  7. Massironi S., et al. “Nutritional deficiencies in inflammatory bowel disease: therapeutic approaches”. Clinical Nutrition6 (2013): 904-910.
  8. Schiesser M., et al. “The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery”. Surgery5 (2009): 519-526.
  9. Saha AK., et al. “Morbidity and mortality after closure of loop ileostomy”. Color Disease8 (2009): 866-871.
  10. Kim MS., et al. “The influence of nutritional assessment on the outcome of ostomy takedown”. Journal of the Korean Society of Coloproctology3 (2012): 145-151.
  11. Dindo D., et al. “Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey”. Annual of Surgery2 (2004): 205-213.
  12. García-Botello SA., et al. “A Prospective Audit of the Complications of Loop Ileostomy Construction and Takedown”. Digestive Surgery 21 (2004): 440-446.
  13. Mijač DD., et al. “Nutritional status in patients with active inflammatory bowel disease: Prevalence of malnutrition and methods for routine nutritional assessment”. European Journal of Internal Medicine 4 (2010): 315-319.
  14. Finnerty CC., et al. “The Surgically Induced Stress Response”. Journal of Parenteral and Enteral Nutrition 37 (2013): 21S-29S.
  15. Amar D., et al. “Inflammation and outcome after general thoracic surgery”. European Journal of Cardio-Thoracic Surgery 3 (2007): 431-434.
  16. Leitch EF., et al. “Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer”. British Journal of Cancer9 (2007): 1266-1270.
  17. Labgaa I., et al. “Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre”. BMJ Open4 (2017): e013966.
  18. Kondrup J., et al. “Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials”. Clinical Nutrition3 (2003): 321-336.
  19. Crowell KT and Messaris E. “Risk factors and implications of anastomotic complications after surgery for Crohn’s disease”. World Journal of Gastrointestinal Surgery10 (2015): 237-242.
  20. Leandro-Merhi VA and de Aquino JLB. “Determinants of malnutrition and post-operative complications in hospitalized surgical patients”. Journal of Health, Population and Nutrition3 (2014): 400-410.
  21. Man VCM., et al. “Morbidities after closure of ileostomy: analysis of risk factors”. International Journal of Colorectal Disease 1 (2016): 51-57.
  22. Saito Y., et al. “Body mass index as a predictor of postoperative complications in loop ileostomy closure after rectal resection in Japanese patients”. Hiroshima Journal of Medical Sciences 4 (2014): 33-38.
  23. El-Hussuna A., et al. “Relatively high incidence of complications after loop ileostomy reversal”. Danish Medical Journal10 (2012): A4517.
  24. Iancu C., et al. “Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer”. Journal of Gastrointestinal and Liver Diseases 3 (2008): 299-303.
  25. Choudhuri AH., et al. “Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: Audit from a tertiary care teaching institute”. International Journal of Critical Illness and Injury Science4 (2013): 246-249.
  26. Yakut M., et al. “Serum vitamin B12 and folate status in patients with inflammatory bowel diseases”. European Journal of Internal Medicine 4 (2010): 320-323.
  27. Murawska N., et al. “Anemia of Chronic Disease and Iron Deficiency Anemia in Inflammatory Bowel Diseases”. Inflammatory Bowel Disease 5 (2016): 1198-1208.
  28. Kaitha S., et al. “Iron deficiency anemia in inflammatory bowel disease”. World Journal of Gastrointestinal Pathophysiology3 (2015): 62-72.
  29. Patel D., et al. “Management of Anemia in Patients with Inflammatory Bowel Disease (IBD)”. Current Treatment Options in Gastroenterology 1 (2018): 112-128.
  30. , et al. “The STROCSS Statement: Strengthening the Reporting of Cohort Studies in Surgery”. International Journal of Surgery 46 (2017): 198-202.
×

Citation

Citation: Joel Bauer., et al. “Nutritional Factors Associated with Complications After Loop Ileostomy Reversal in Patients with Inflammatory Bowel Disease". Acta Scientific Gastrointestinal Disorders 4.1 (2021): 09-15.




Metrics

Acceptance rate35%
Acceptance to publication20-30 days

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is September 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US