Renal Insufficiency After Colectomy With or Without Ileostomy

Abstract

Introduction

In colorectal surgeries, ileostomies are known to cause dehydration due to fluid and electrolyte loss. Dehydration can contribute to renal insufficiency (RI). Therefore, this study focused on clinical factors associated with postoperative RI.

Methods

We utilized the 2022 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted colectomy database to analyze colectomy cases. Those who had preoperative renal failure or received a prior ileostomy were excluded. Patients were divided based on whether or not they received an ileostomy, and further grouped based on whether or not they experienced postoperative RI yielding four cohorts: patients who did not receive an ileostomy with no postoperative RI (Control-A), patients who did not receive an ileostomy with postoperative RI (RI-A), patients who received an ileostomy with no postoperative RI (Control-B), and patients who received an ileostomy with postoperative RI (RI-B).

Results

Patients in the Ileostomy cohort experienced higher rates of postoperative RI than the No-Ileostomy group (7.59% vs 5.98%; P = 0.016). Multivariate logistic regression indicated that colectomy with ileostomy formation, preoperative congestive heart failure, hypertension, chronic obstructive pulmonary disease, smoking, and diabetes were all independently associated with significantly higher odds of developing postoperative RI.

Conclusion

Receiving an ileostomy and several other preoperative clinical factors were associated with higher rates of postoperative RI. Based on these findings, focusing more on these factors would be beneficial to minimize the risk of postoperative RI after a colectomy.