Characteristics, Hospital Length of Stay, and Readmissions Among Individuals Undergoing Abdominal Ostomy Surgery

Abstract

PURPOSE: The purpose of this study was to examine patient characteristics, length of stay (LOS), hospital revisits, and complications of patients undergoing abdominal ostomy surgery. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: Data were extracted from the PINC AI Healthcare Database (PHD), a large archive that stores data from 25% of all US inpatient hospital discharges. Patients were admitted to 658 hospitals in the United States between December 1, 2017, and November 30, 2018. The sample comprised 27,658 adult patients; 15,512 underwent creation of a colostomy, 10,207 underwent ileostomy construction, and 1930 had a urostomy procedure. Their median age was 64 years (interquartile range [IQR] = 19 years). Emergent admission type was 71.2% for patients who underwent a colostomy procedure, 49.4% for ileostomy, and 9.9% for urostomy. The majority of patients underwent open surgery (77.7%); 22.3% of procedures used an endoscopic approach. METHODS: Patients were identified as having undergone abdominal ostomy surgery via ICD-10-PCS (International Classification of Diseases, Tenth Revision, Procedure Coding System) procedure codes. Demographic, visit, hospital and clinical characteristics, LOS, and hospital revisits (ie, readmissions and emergency department [ED]) were captured for qualifying patients. Data were evaluated using unadjusted descriptive analyses. RESULTS: The median LOS of 9 days (IQR = 9 days) varied by ostomy surgery; the cumulative postsurgical LOS was 7 days (IQR = 5 days). The most frequent underlying diagnoses resulting in ostomy surgery were diverticulitis of the large bowel (19.6%) managed by colostomy, colorectal cancer managed by ileostomy (22.5%), or urothelial cancer managed by urostomy (78.1%). Slightly less than a quarter (23.7%) of patients were discharged home without home care, 43.0% went home with home healthcare, and 29.6% were discharged to a non–acute care facility. Hospital readmission within 120 days of discharge was 36.3% for patients with a colostomy, 52.3% for those with an ileostomy, and 34.6% for patients with a urostomy. Ostomy complications were identified as the reason for readmission in 62.4% of patients. Slightly more than 1 in 5 patients (20.7%) had a subsequent ED visit within 120 days, 39.7% of which involved ostomy complication. CONCLUSIONS: Characteristics of patients undergoing abdominal stoma surgery varied based on underlying diagnosis and ostomy type. The median hospital LOS was more than 1 week. Patients experienced high rates of healthcare utilization (hospital admission or ED visits) during the 120 days following surgery.

Predictors of Hospital Readmission in Patients Undergoing Creation of an Intestinal Ostomy

“…Patients who undergo intestinal ostomy surgery are reported to have high rates of rehospitalization 1–4,8. Identifying the risk factors that contribute to these readmissions is an important first step to reversing this trend.…”

“…A large archive of data from approximately 25% of all hospital admissions in the United States suggests that more than 110,000 new ostomies are created annually 1. For patients undergoing ostomy surgery, the risk for hospital readmission is high.…”

“…A large archive of data from approximately 25% of all hospital admissions in the United States suggests that more than 110,000 new ostomies are created annually. 1 For patients undergoing ostomy surgery, the risk for hospital readmission is high. In studies that have examined readmissions following colostomy or ileostomy creation, rates are reported in the range of 15% by 30 days, with 28% to 42% of readmissions occurring in the first 12 days following surgery.…”

Best Practice Guidelines for Ostomy Care in Neonates, Children, and Adolescents

“…Approximately 725,000 to 1 million people residing in the United States are living with an ostomy, and more than 100,000 undergo ostomy surgery annually 1. We searched the literature but found no epidemiologic data for ostomy surgery in the pediatric population.…”

“…Approximately 725,000 to 1 million people residing in the United States are living with an ostomy, and more than 100,000 undergo ostomy surgery annually. 1 We searched the literature but found no epidemiologic data for ostomy surgery in the pediatric population. An improved understanding of the physiologic and psychological consequences of an abdominal stoma and ostomy care has contributed to better selection of neonates, children, and adolescents requiring ostomy surgery.…”