Diuresis as an indicator of the resolution of ileus
*Robin Riley, *Sarah Kelso, *Tom Ahern, James Murphy
University of Vermont Medical Center, Burlington, VT
1. OBJECTIVE
Studies show that none of the current indicators accurately predict the timing of ileus resolution. We hypothesize that auto-diuresis is an early indicator of ileus resolution.
2. DESIGN
Retrospective cohort study.
3. SETTING
This study included a series of pediatric surgical patients with laparotomies from 9/30/2016 to 2/15/2019 at a tertiary care center.
4. PATIENTS OR OTHER PARTICIPANTS
Twenty-seven patients were included, with 33 total surgeries. This was a consecutive series of patients treated by our two pediatric surgeons. Five surgeries were excluded for lack of fluid status information, and one surgery was excluded because of re-exploration for an unresolved ileus.
5. INTERVENTION(S)
Open abdominal surgery.
6. MAIN OUTCOME MEASURE(S)
The post-operative urinary output and timing of diuresis and how that related to the timing of first flatus or bowel movement was out main outcome.
7. RESULTS
An accelerated failure time model was created to estimate the association between increased urinary output and time to first flatus or stool. Median time to first flatus or stool was 2.5 days.
Daily post-operative urine output was profiled on a lasagna plot that shows considerable inter-patient variability in postoperative urine output profiles (Figure 1). Diuresis was associated with a shorter time to first flatus or stool (HR per 100 cc increase=1.07, 95% CI: 0.998, 1.15; P=0.058).
8. CONCLUSIONS
We conclude that auto-diuresis may be an early indicator of ileus resolution, but evaluation of a larger data set with more information about oral intake and potentially confounding patient factors is necessary. 
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