BACKGROUND 29% of post-ileostomy discharges are readmitted, most commonly due to dehydration. However, there is a lack of detailed data specifically evaluating factors associated with readmission with dehydration. Additionally, patients with a history of an ileostomy have often been excluded from previous studies, and therefore represent a group of understudied ileostomates. OBJECTIVE To evaluate factors available at discharge associated with 30-day readmission for dehydration, rather than all-cause readmissions. DESIGN This was a retrospective cohort study. SETTING Study patients received ileostomies at a tertiary academic medical center from 2014–2016. PATIENTS Patients with a pre-existing ileostomy which was not recreated per the operative note were excluded, while those who received a new ileostomy were included. MAIN OUTCOME MEASURE 30-day readmission for dehydration as defined by objective clinical criteria. RESULTS A total of 262 patients underwent ileostomy creation and were discharged alive. 25% were aged ≥65, 53% were male, 14% had a history of ileostomy, 18% had a creatinine >1.0 on discharge, and 26% had high ileostomy output at any time during the index admission. Among all ileostomates, the all-cause rate was 30%. Mean days to readmission for any cause was 8.5 while for dehydration it was 11.6 days. Of the readmissions, 37% were readmitted with a diagnosis of dehydration, and dehydration was the sole reason in 26%. Among those with dehydration, the most common length of stay was 2 days. In multivariable logistic regression, 30-day readmission with dehydration was associated with older age, male sex, history of an ileostomy, high ileostomy output during index admission, and a discharge creatinine >1.0. LIMITATIONS Retrospective design. CONCLUSIONS Ileostomy dehydration efforts have focused on new ileostomy patients; however, our data suggests that patients with a history of an ileostomy are actually at risk for readmission with dehydration. Further studies aimed at reduction of readmission with dehydration after ileostomy are warranted and should include patients with a history of an ileostomy. See Video Abstract at http://links.lww.com/DCR/A643.

Our results indicate that when controlled for patient, tumor, and hospital factors, patients who traveled a long distance to a high-volume center had improved lymph node yield, neoadjuvant chemoradiation receipt, and 30- and 90-day mortality compared with those who traveled a short distance to a low-volume center. They also had improved 5-year survival. See Video Abstract at http://links.lww.com/DCR/A446.

Emergent resection for colon cancer is independently associated with poor short-term outcomes and decreased 5-year OS compared to elective resection. With 30% of cases in this study emergent, these findings underlie the importance of adherence to colon cancer screening guidelines to limit the need for emergent resections.

OBJECTIVE Post-emergency department (ED) triage of older trauma patients continues to be challenging as morbidity and mortality for any given level of injury severity tend to increase with age. The Comorbidity-Polypharmacy Score (CPS) combines the number of pre-injury medications with the number of comorbidities to estimate the severity of co-morbid conditions. This retrospective study examines the relationship between CPS and triage accuracy for older (≥45 years) patients admitted for traumatic injury. METHODS Patients ≥ 45 years old presenting to level 1 trauma center from 2005 to 2008 were included. Basic data included patient demographics, injury severity score (ISS), morbidity/mortality, and functional outcome measures. CPS was calculated by adding total numbers of co-morbid conditions and pre-injury medications. Patients were divided into 3 triage groups: undertriage, appropriate triage, and over-triage. Under-triage criteria included initial admission to the floor or step-down unit followed by an unplanned transfer to ICU within 24 hours of admission. Over-triage was defined as initial ICU admission for <1 day without stated need for ICU level of care (i.e., lack of evidence for tracheal intubation/mechanical ventilation, injury-related hemorrhage, or other traditional ICU indications such as intracranial bleeding). All other patients were presumed to be correctly triaged. The three triage groups were then analyzed looking for contributors to mis-triage. RESULTS Charts for 711 patients were evaluated (mean age 63.5, 55.7% male, mean ISS 9.02). Of those, 11 (1.55%) met criteria for “under-triage” and 14 (1.97%) were “over-triaged”. The remaining 686 patients had no evidence of mis-triage. The three groups were similar in terms of injury severity and age. The groups were significantly different with respect to CPS, with undertriage CPS scores (14.9±6.80) being nearly three times higher than the overtriage CPS scores (5.14±3.48). There were more similarities between appropriate and overtriage groups, with the undertriage group being characterized by greater number of complications, and lower functional outcomes at discharge (all, p<0.05). The undertriage group had significantly higher mortality (27%) than the appropriate and over-triage groups (6% and 0%, respectively). CONCLUSION In the era of medication reconciliation, the CPS is easy to obtain and calculate in patients who are not critically injured. This study suggests that CPS may be a promising adjunct in identifying older trauma patients who are more likely to be under-triaged. The significance of our findings is especially important when considering that injury severity in the undertiage group was similar to injury severity in the other groups. Further evaluation of CPS as a triage tool in acute trauma is warranted.