O2148: Slow Down Fluids to Speed Up The Intestine - Exploring Post-Operative Ileus in Pediatric Gastrointestinal Surgery

Background: Post-operative ileus is a common complication of gastrointestinal (GI) surgery. The etiology of ileus is not fully understood and associations with generous intraoperative intravenous (IV) fluid use have been demonstrated in adult populations. This study examines the relationship between intraoperative IV fluids and post-operative ileus in pediatric patients undergoing GI surgery.

Methods: A prospective cohort study was conducted, using data (July 2020-January 2024) from a multi-center (18 pediatric hospitals) trial of the implementation of an enhanced recovery after surgery (ERAS) protocol for patients, ages 10-18 years old, who were undergoing non-emergent GI surgery. Descriptive statistics, student t tests and chi squared tests were used to compare patients who experienced post-operative ileus, defined as delay of bowel function requiring nasogastric tube placement or delay of oral intake without signs of obstruction, compared to those who did not. The exposure variable of interest was amount of intraoperative IV fluids and the outcome variable being post-operative ileus within 30 days of surgery.

Results: Of 553 patients, 39 (7%) had postoperative ileus. Patients who experienced ileus had a higher mean amount (1453 mL, SD=822 mL, vs. 1180 mL, SD=1006 mL, p=0.02) and higher rate (9.2 mL/kg/h compared to 7.4 mL/kg/h, p=0.03) of IV crystalloid fluid intraoperatively than for those who did not. The percentage of ileus was 4% when receiving less than 5 mL/kg/h, 6.3% when receiving 6 mL/kg/h to 10 mL/kg/h, and 13.6% when receiving >10 mL/kg/h (Figure). Patients with ileus had a longer length of stay compared to those who did not (11.3 days, SD=10.7 days, vs. 4.9 days, SD=6.2 days, p< 0.001) There were no statistically significant differences when comparing indication for surgery, type of surgery, American Society for Anesthesiologist (ASA) physical status score, preoperative opioid use, operative technique (e.g., minimally invasive vs open), and type of anastomosis (e.g., stapled vs handsewn).

Conclusion: Post-operative ileus in pediatric patients undergoing GI surgery is associated with higher amounts of intraoperative IV fluids and is associated with increased length of stay. Limiting intraoperative IV fluids is a key target for ERAS protocols and illustrates opportunities for coordinated care between surgical and anesthesia teams.