Hypophosphatemia Is Associated With Postoperative Morbidity After Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy: A Retrospective Study

Shaltiel, Tali; Gleeson, Elizabeth M.; Pletcher, Eric; Golas, Benjamin; Magge, Deepa; Sarpel, Umut; Labow, Daniel M.; Cohen, Noah A.

doi:10.1016/j.jss.2022.03.010

Cited by 2 publications

(2 citation statements)

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“…One study concluded that hypophosphatemia may have some prognostic value for abdominal organ specific surgeries, possibly serving as an early indication for anastomotic leak (9). Another study showed hypophosphatemia during POD 5 through 7 after cytoreductive surgery or hyperthermic intraperitoneal chemotherapy is associated with more complications and risk of anastomotic leak (8).…”

Section: Introductionmentioning

confidence: 99%

“…Hypophosphatemia, defined as a serum phosphate level < 2.5 mg/dL, has been highlighted in patients who have undergone gastrointestinal resections, including hepatic, pancreatic, colorectal, and gastric. These studies have shown that low levels of phosphate following post-operative day (POD) 2 are associated with increased rates of complications and morbidity (8)(9)(10). One study concluded that hypophosphatemia may have some prognostic value for abdominal organ specific surgeries, possibly serving as an early indication for anastomotic leak (9).…”

Section: Introductionmentioning

confidence: 99%

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Hypophosphatemia Is Associated with Post-Operative Ileus After Right Colon Resection

Yu,

Malhotra,

Abeshouse

et al. 2024

Preprint

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Background: Electrolyte imbalances are known to contribute to intestinal ileus. However, the direct impact of hypophosphatemia on post-operative ileus (POI) is unknown. Objective: To describe post-operative phosphate dynamics and if hypophosphatemia is associated with POI after a right colon resection. Design: Comparative retrospective cohort study Settings: High-volume tertiary referral center Patients: Patients who underwent right colon resection, which includes right hemicolectomies and ileocolic resections between 2020 and 2022. Main Outcome Measures: POI incidence, post-surgical phosphate dynamics, and post-operative phosphate deficit and recovery. Results: A total of 396 patients were reviewed, where 68% of resections were for inflammatory bowel disease. Patients had a mean return of bowel function on POD 3.78 +/- 1.45. 17.4% of patients overall had POI. Serum phosphate was the most dynamic post-operative electrolyte, with statistically significant differences between POI and non-POI on POD 1, 3, and 7 (p < 0.05). Serum phosphate recovery in patients with POI was impaired at 0.11 mg/dL/day versus 0.17 mg/dL/day (p < 0.001). Patients with POI had a phosphate deficit that persisted beginning on POD 2, with statistically significant deficits on POD 3-5 (p < 0.01), as well as POD 7 (p < 0.001). On multivariate analysis, a phosphate deficit on POD 3 (ORadj 9.04, 95% CI 1.38-59.2), POD 5 (ORadj 7.05, 1.13-44.1), and POD 7 (ORadj 47.2, 2.98-749.4) were the only independent risk factors for POI. Limitations: Generalizability of these findings may be limited outside of right colon resections. Conclusions: We have established baseline phosphate dynamics in patients who undergo ileocolic anastomoses. We found POI was associated with a delayed serum phosphate recovery, as well as lower overall phosphate levels. Thus, a potential post-surgical window for intervention with timed phosphate repletion may have the potential to reduce post-operative ileus, need for nasogastric decompression, and ultimately decrease hospital length of stay. Keywords: phosphate, post-operative ileus, electrolytes, return of bowel function, colon resection, Crohn's disease, ileocolic resection

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Section: Introductionmentioning

confidence: 99%