A novel patient-centered protocol to reduce hospital readmissions for dehydration after ileostomy

Gonella, Federica; Valenti, Antonio; Massucco, Paolo; Russolillo, Nadia; Mineccia, Michela; Fontana, A.; Cucco, D; Ferrero, Alessandro

doi:10.1007/s13304-019-00643-2

Cited by 21 publications

(20 citation statements)

References 18 publications

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“…However, there is little agreement between studies regarding which risk factors are found to be predictive. Thus far, the majority of publications have included ileostomy patients from North America, Europe and Asia, with a paucity of studies from Australia and New Zealand (NZ) 13–15 …”

Section: Introductionmentioning

confidence: 99%

Re‐admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre

Bhat

O’Grady

Bissett

2020

ANZ Journal of Surgery

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Ileostomy formation is associated with significant morbidity risk, especially for unplanned hospital re‐admissions and dehydration. This retrospective analysis of a New Zealand tertiary surgical centre evaluated the incidence of unplanned re‐admissions within 60 days of discharge following ileostomy formation over a 4‐year period and identified independent predictors. Our results confirm unplanned re‐admissions to be a significant issue in New Zealand.

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Section: Introductionmentioning

confidence: 99%

Re‐admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre

Bhat

O’Grady

Bissett

2020

ANZ Journal of Surgery

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“…This paper is a retrospective study with some limitations. A prospective study should pay attention to the patients with high-risk factors HOS, strengthen the supervision and treatment after the operation and discharge for reducing the complications of stoma, and facilitate the smooth progress of comprehensive treatment and the readmission rate caused by HOS [ 21 – 24 ]. Furthermore, HOS generally increases the length of hospitalization, the cost of hospitalization, and the readmission rate, leading to clinical pathway variation, while details are not yet available.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for developing high-output ileostomy in CRC patients: a retrospective study

Bai

Shen

et al. 2021

BMC Surg

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Background Anastomotic leakage is one of the most serious postoperative complications of rectal cancer. Prophylactic ileostomy has been widely used to reduce the risk and severity of complications of anastomotic leakage. However, prophylactic ileostomy itself has some complications, and ileostomy high output syndrome (HOS) is one of them. This study was performed to explore the risk factors of HOS in ileostomy. Methods A total of 114 patients with HOS were screened out from 494 eligible ileostomy patients in the last 5 years. The relationship between HOS and the clinicopathological data was analyzed using the Chi-square test and Fisher’s exact probability. Multivariate analysis was performed by logistic regression. Results The incidence of HOS was 23.07% in this study. Dehydration was the most common symptom of HOS (37.7%). There was no clear correlation between HOS occurrence with sex, age, gross typing, histological grade, tumor location, lymph node metastasis, and TNM stage (p > 0.05). The incidence of HOS was 14/18 in inflammatory bowel disease patients, 18/28 in diabetes mellitus patients, and 23/72 in neoadjuvant chemoradiotherapy patients, 13/17 in total colectomy and abdominal infection patients. Multivariate analysis showed that they are risk factors for HOS (p < 0.05). Conclusion HOS occurred occasionally but rarely studied and lacks attention. Inflammatory bowel disease, diabetes mellitus, neoadjuvant radiotherapy chemotherapy, total colectomy and abdominal infection are the risk factors for HOS.

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“…Prevention and patient education are key features to avoid readmission secondary to dehydration and ileostomy-related problems. Currently, a patient-centered protocol and follow-up to detect complications at an early stage via teleconsulting by a specialist nurse are under investigation at our department [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel?

Butsele¹,

Bislenghi²,

D’Hoore³

et al. 2021

BMC Surg

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Background Rectal resection surgery is often followed by a loop ileostomy creation. Despite improvements in surgical technique and development of enhanced recovery after surgery (ERAS) protocols, the readmission-rate after rectal resection is still estimated to be around 30%. The purpose of this study was to identify risk factors for readmission after rectal resection surgery. This study also investigated whether elderly patients (≥ 65 years old) dispose of a distinct patient profile and associated risk factors for readmission. Methods This is a retrospective study of prospectively collected data from patients who consecutively underwent rectal resection for cancer within an ERAS protocol between 2011 and 2016. The primary study endpoint was 90-day readmission. Patients with and without readmission within 90 days were compared. Additional subgroup analysis was performed in patients ≥ 65 years old. Results A total of 344 patients were included, and 25% (n = 85) were readmitted. Main reasons for readmission were acute renal insufficiency (24%), small bowel obstruction (20%), anastomotic leakage (15%) and high output stoma (11%). In multivariate logistic regression, elevated initial creatinine level (cut-off values: 0.67–1.17 mg/dl) (OR 1.95, p = 0.041) and neoadjuvant radiotherapy (OR 2.63, p = 0.031) were significantly associated with readmission. For ileostomy related problems, elevated initial creatinine level (OR 2.76, p = 0.021) was identified to be significant. Conclusion Recovery after rectal resection within an ERAS protocol is hampered by the presence of a loop ileostomy. ERAS protocols should include stoma education and high output stoma prevention.

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A novel patient-centered protocol to reduce hospital readmissions for dehydration after ileostomy

Cited by 21 publications

References 18 publications

Re‐admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre

Re‐admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre

Risk factors for developing high-output ileostomy in CRC patients: a retrospective study

Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel?

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