Potential Correlation Study Between Prolonged Postoperative Ileus (POI) And Perioperative Controlled Fluid Therapy In Patients With Colorectal Tumors

Background:Postoperative ileus is a frequently occurring surgical complication,it remains a difficult issue for surgeons,leading to increase hospital stay and costs and delaying recovery efficiency.Objective: The aim of this study was to analyze the effect of perioperative fluid management on the occurrence of intestinal obstruction after colorectal surgery in the context of complete enhance recovery after surgery.Design: This is a retrospective study designed based on the case system of Jiangsu Subei People’s HospitalPatients: The study included patients with benign or malignant colorectal tumors who underwent colorectal resection at Jiangsu Subei People’s Hospital between 2020 and 2022.Main outcome measures: POI is defined as the prolonged recovery time of gastrointestinal function after surgery due to non-mechanical factors,resulting in the inability of patients to take in food by mouth,which is characterized by impaired gastrointestinal motility and can be clinically manifested as postoperative nausea,vomiting,abdominal pain and cessation of gas and defecation.In order to distinguish "physiological POI",the concept of "delayed POI" is proposed based on systematic evaluation and investigation,which means that two or more of the following four items are still present on postoperative day 4:(1)nausea or vomiting;(2)inability to tolerate oral diet in the previous 24h;(3)failure to restore ventilation in the previous 24h;(4)abdominal distention or imaging confirmation of bowel distention without mechanical intestinal obstruction.To compare perioperative fluid management and surgical outcomes in patients with and without intestinal obstruction.In this paper,SPSS25.0 was used for statistical analysis of the data.In the descriptive statistics process,for categorical variables,frequencies as well as percentages were used,and the chi-square test was applied;for continuous variables and count variables,means,standard deviations or medians and interquartile spacing were used for statistical reporting,and the data were first tested by normality test,and t-test was used for data with normal distribution;data with skewed distribution then the rank sum test was used.All significant(p<0.05 as statistically different)data variables were analyzed by multi-factor logistic regression,thus estimating the ratio of ratios(OR).A subject operating characteristic operating curve(ROC curve)was also established based on the amount of fluid in the data to determine the optimal cut-off value for perioperative fluid management in the data,and the Yuoden index was also calculated with the formula: the specificity and sensitivity were added and subtracted by 1.The value to which the Yuoden index was maximized was the optimal cut-off value,and the area under the curve(AUG)with 95% confidence interval was calculated to estimate the The predictive value of perioperative fluid therapy for the development of postoperative delayed bowel paralysis in patients undergoing colorectal tumor surgery,with p<0.05 being statistically different.Result: Of the 200 patients included,37(18.5%)had postoperative intestinal obstruction on day 4(interquartile range,days 2-5).Among them,the amount of fluid infusion was3.2 ± 2.6 L in patients with postoperative ileus and 2.5 ± 1.7 L in the remaining patients(p < 0.01).All significant(p < 0.05)demographic,humoral management-related,and surgical risk factors from the univariate analysis of postoperative intestinal obstruction(POI)were included in the multifactorial analysis,POD0>3 L(OR = 1.62(95% CI,1.13-2.41);p=0.004);the occurrence of postoperative anastomotic fistula(OR = 1.9(95% CI,1.39-2.90;p=0.044)was an independent risk factor for postoperative Ileus.Limitations: This study is a retrospective analysis with a small sample size,while controlled fluid infusion depends on patient,disease and procedure-related factors and cannot be generalized and extrapolated.Conclusions: 1.excessive postoperative fluid volume POD0>3 L(OR = 1.62(95% CI,1.13-2.41);p=0.004);and the development of postoperative anastomotic fistula(OR =1.9(95% CI,1.39-2.90;p=0.044)were independent risk factors for the development of POI.Therefore,perioperative control of fluid rehydration is very important and requires surgeons to take steps to limit the amount of fluid.2.Within the broad context of standardized ERAS,limiting postoperative fluid volumes in colorectal patients to as much as possible within the above fluid thresholds may help to reduce the incidence of POI,while avoiding fluids >3 L on day 0 may improve the prognosis of patients undergoing colorectal surgery given the significant correlation between POI and postoperative morbidity.3.Patients who developed PPOI postoperatively had longer hospital days and increased total hospital costs costs compared to those who did not develop PPOI.