P1063 - ELEVATED EXTRACELLULAR WATER TO TOTAL BODY WATER RATIO IS ASSOCIATED WITH POSTOPERATIVE ILEUS DEVELOPMENT AFTER RADICAL CYSTECTOMY

P1063

ELEVATED EXTRACELLULAR WATER TO TOTAL BODY WATER RATIO IS ASSOCIATED WITH POSTOPERATIVE ILEUS DEVELOPMENT AFTER RADICAL CYSTECTOMY

N. Tetlow^1,2,*, A. Beebeejaun¹, T. Boucher¹, S. Kerneis¹, A. Menon¹, C. Musonda¹, N. Cruz Rodriguez¹, J. Whittle^1,2

¹Department of Targeted Intervention, Centre for Perioperative Medicine, Human Physiology and Performance Laboratory (HPPL) , University College London, ²Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London , United Kingdom

Rationale: Bio-electrical impedance analysis (BIA) is a simple, non-invasive tool to assess perioperative fluid balance. An elevated extracellular to total body water ratio (ECW/TBW) indicates impaired vascular barrier integrity. This may increase the risk of gastrointestinal oedema and the development of postoperative ileus (POI), leading to a prolonged length of stay (LOS). We hypothesised that a higher preoperative ECW/TBW is associated with increased risk of POI, trunk oedema and longer LOS.

Methods: Patients undergoing radical cystectomy for bladder cancer were recruited to the Perioperative Medicine Metabolic Profiling study (Jan 2023–Jan 2024). BIA was performed preoperatively and on postoperative day (POD) 3 and 5 using InBody BWA 2.0. Ileus was defined as a binary outcome based on clinical features (abdominal distension, vomiting, inability to tolerate oral intake, absence of bowel function) with requirement for nasogastric tube insertion. Associations were analysed using simple logistic regression and Spearman’s rho; group differences by Mann-Whitney U test. Significance was set at P<0.05.

Results: Of 20 patients enrolled (Table 1), 5 (25%) developed POI and had higher median (IQR) preoperative ECW/TBW [0.398 (0.392–0.405) vs 0.386 (0.382–0.396); P=0.02]. Preoperative ECW/TBW strongly correlated with trunk ECW/TBW on POD3 (ρ=0.80, 95% CI 0.52–0.92; P<0.001) and POD5 (ρ=0.69, 95% CI 0.33–0.87; P=0.001). ECW/TBW showed good discrimination for POI (AUROC 0.84, 95% CI 0.65–1.00; P=0.026). Patients with ECW/TBW >0.388 had longer hospital LOS [13 (8-16) vs 8 (6-8) days; P=0.019].

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Conclusion: Elevated preoperative ECW/TBW was associated with postoperative trunk oedema and postoperative ileus after radical cystectomy. BIA may offer a non-invasive method to identify patients at risk, supporting preoperative counselling and perioperative planning.

Disclosure of Interest: None declared