Effect of intraoperative fluid volume on postoperative ileus after robot-assisted radical cystectomy

Abstract

This study aimed to investigate the effect of intraoperative fluid volume on the postoperative ileus (POI) recovery period. A retrospective review of the Korean robot-assisted radical cystectomy database identified 718 patients who underwent robot-assisted radical cystectomy (RARC). Regression analyses were performed to identify the associations between the amount of intraoperative fluid administration (crystalloid/colloid/total), POI period (time to flatus/bowel movements), and length of hospital stay (LOS) after adjusting for covariates. In addition, we analyzed the risk factors for gastrointestinal complications and prolonged POI using a logistic regression model. An increasing volume of the administered crystalloid/total fluid was associated with prolonged POI (crystalloid R² = 0.0725 and P < 0.0001; total amount R² = 0.0812 and P < 0.0001), and the total fluid volume was positively associated with the LOS (R² = 0.099 and P < 0.0001). The crystalloid amount was a risk factor for prolonged POI (P < 0.001; odds ratio, 1.361; 95% confidence interval, 1.133-1.641; P < 0.001). In the context of RARC, increased intravenous fluids are associated with prolonged POI and longer LOS.

Figure 1

Linear regression analysis of the associations between intraoperative intravenous fluids and the postoperative ileus period as time to flatus; (a) total fluids, (b) crystalloid (blue long dash line—95% confidence band, red short dash line—95% prediction band).

Figure 2

Regression curves on the analysis of the association between intraoperative intravenous total fluids and length of hospital stay.