Factors associated with hospital readmission following diverting ileostomy creation

Li, W.; Stocchi, Luca; Cherla, Deepa V.; Liu, G.; Agostinelli, Andrea; Delaney, Conor P.; Steele, Scott R.; Görgün, Emre

doi:10.1007/s10151-017-1667-z

Cited by 39 publications

(56 citation statements)

References 36 publications

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“…Two larger studies have attempted to identify factors associated with readmission after ileostomy creation. 16 , 17 Dehydration was the most frequent cause of readmission in one study, 17 as it was in our study but was rarely seen (3%) in another study. 16 Our study differs from the others by creating a model for predicting and identifying modifiable factors, influencing which ones might help reduce the readmission rate.…”

Section: Discussionsupporting

confidence: 66%

“… 16 , 17 Dehydration was the most frequent cause of readmission in one study, 17 as it was in our study but was rarely seen (3%) in another study. 16 Our study differs from the others by creating a model for predicting and identifying modifiable factors, influencing which ones might help reduce the readmission rate. In addition, we looked at some risk factors that are less well known, such as the involvement of stoma nurses and hospital social workers in discharge planning.…”

Section: Discussionsupporting

confidence: 66%

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Readmission After Elective Ileostomy in Colorectal Surgery Is Predictable

Iqbal¹,

Sakharuk

Goldstein³

et al. 2018

JSLS

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Background and Objectives:Patients who undergo colorectal surgery have high postoperative morbidity, with ileostomates being the most disadvantaged. Recent studies assessing readmission risk factors do not provide a specific prediction model and, if so, do not focus on patients who have had colorectal surgery; thus, the results of these studies have limited applicability to our specialized practice. We wanted to develop a prediction model for readmission within 30 days of discharge after ileostomy creation.Methods:Patients who underwent elective ileostomy creation from 2013 to 2016 at the University of Florida were included in this retrospective study. Factors significantly associated with readmission within 30 days after discharge were identified by comparing a cohort that was readmitted within 30 days with one that was not. A practical, predictive model that stratified a patient's risk of readmission after the index procedure was developed.Results:A total of 86 iliostomates were included; of those, 22 (26%) were readmitted within 30 days. Factors significantly associated with readmission included preoperative steroid use, history of diabetes, history of depression, lack of a hospital social worker or postoperative ostomy education, and the presence of complications after the index procedure. A model predicting readmission within 30 days of discharge that comprised the first 4 factors was developed, with a sensitivity of 73% and a specificity of 77%.Conclusion:Prediction of readmission in patients who undergo ileostomy creation is possible, suggesting interventions addressing predictive factors that may help decrease the readmission rate. Prospective validation of the model in a larger cohort is needed.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionsupporting

confidence: 66%

Readmission After Elective Ileostomy in Colorectal Surgery Is Predictable

Iqbal¹,

Sakharuk

Goldstein³

et al. 2018

JSLS

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“…Other adverse events such as parastomal hernia and stoma stenosis have been reported as well . These consequences may impact negatively on the patient's overall quality of life .…”

Section: Introductionmentioning

confidence: 99%

Reversal of defunctioning stoma following rectal cancer surgery: are we getting better? A population‐based single centre experience

Gadan

Lindgren

Matthiessen

2019

ANZ Journal of Surgery

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Background: The aim was to assess factors influencing the timing of defunctioning stoma (DS) reversal following low anterior resection of rectum for cancer (LAR). Methods: All patients operated with LAR and a primary DS during a 9-year period were included. Reversal later than 120 days after LAR was considered as delayed. A DS not reversed within 2 years was considered as permanent.Results: In the present study, median age at LAR was 67 years, 45% were females, median body mass index was 25, 87% had American Society of Anesthesiologists class I or II, 64% had pre-operative radiotherapy, and 3% had cancer stage IV. A total of 79% (92/116) underwent stoma reversal, whereof 25% (23/92) were reversed within 120 days. The most common health-related reasons for delayed stoma reversal were adjuvant chemotherapy in 38%, symptomatic anastomotic leakage in 16% and other post-operative adverse events in 13%. In 35% delayed stoma reversal was because of low priority within the healthcare system. A total of 18% (20/110) never had their DS reversed (n = 11) or had their DS converted to a permanent end colostomy (n = 9). Major risk factors for permanent stoma were stage IV cancer in 55%, and symptomatic anastomotic leakage in 30%. Conclusion: One fourth of the patients had their defunctioning stoma reversed within 120 days. The most common identifiable medical reasons for delayed stoma reversal were adjuvant chemotherapy and symptomatic anastomotic leakage, while in one out of three patients it was because of low priority by the healthcare provider.

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“…However, a diverting ileostomy can result in substantial complications, such as bowel obstruction, parastomal hernia, prolapse, and dermatitis [10,11]. More importantly, significant morbidity, such as high-output stoma (HOS), dehydration, electrolyte imbalance, and acute kidney injury (AKI), may cause readmission after rectal cancer surgery with diverting ileostomy [12][13][14][15][16][17][18][19]. Readmission rates after ileostomy creation have been reported to range between 12.9-30% [12][13][14][15][16][17][18].…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

The Relationship Between High-Output Stomas, Postoperative Ileus, and Readmission After Rectal Cancer Surgery With Diverting Ileostomy

Lee

Kim

et al. 2021

Ann Coloproctol

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This study aimed to evaluate the relationship between high-output stomas (HOSs), postoperative ileus (POI), and readmission after rectal cancer surgery with diverting ileostomy. Methods: We included 302 patients with rectal cancer who underwent restorative resection with diverting ileostomy between January 2011 and December 2015. HOSs were defined as stomas with ≥2000 mL/day output. We analyzed predictive factors for readmission of these patients. Results: Forty-eight (15.9%) patients had HOSs during the hospital stay, and 41 (13.6%) patients experienced POI. HOSs were strongly associated with POI (45.8 vs. 7.5%, p<0.001). The all-cause readmission rate was 16.9%, with 19 (6.3%) and 20 (6.6%) patients experiencing ileus and acute kidney injury, respectively. HOSs (27.1 vs. 15.0%, p=0.040) and POI (34.1 vs. 14.2%, p=0.002) were associated with all-cause readmission, and POI was associated with readmission with ileus (17.1 vs. 4.6%, p=0.007). POI was an independent risk factor for all-cause readmission (adjusted odds ratio [OR]=2.640; 95% confidence interval [CI] 1.162-6.001; p=0.020) and readmission with ileus (adjusted OR=3.869; 95% CI 1.387-10.792; p=0.010). Conclusions: POI was associated with readmission, particularly for subsequent ileus, in patients with diverting ileostomy. We should make efforts to reduce POI, such as strong control of HOSs, to prevent readmission.

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Factors associated with hospital readmission following diverting ileostomy creation

Abstract: Dehydration associated with diverting ileostomy creation was relevant as an individual cause of readmission, but its overall incidence was relatively rare. Dedicated strategies to prevent dehydration should be directed to patients who received chemoradiotherapy and/or laparoscopic surgery.

Cited by 39 publications

References 36 publications

Readmission After Elective Ileostomy in Colorectal Surgery Is Predictable

Readmission After Elective Ileostomy in Colorectal Surgery Is Predictable

Reversal of defunctioning stoma following rectal cancer surgery: are we getting better? A population‐based single centre experience

The Relationship Between High-Output Stomas, Postoperative Ileus, and Readmission After Rectal Cancer Surgery With Diverting Ileostomy

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