Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme

Younis, Jenan; Salerno, Gisella; Fanto, Daniela; Hadjipavlou, Marios; Chellar, Daniel; Trickett, J. P.

doi:10.1007/s00384-011-1252-2

Cited by 98 publications

(62 citation statements)

References 22 publications

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“…This rate may be lower than those of previously published reports as a result of differences in patient population as well as extensive patient education regarding hydration and titration of anti-diarrheal medications, aggressive surveillance by nursing staff, close follow-up, and servicing a well-educated population. Several prospective studies have successfully employed educational interventions and “ileostomy pathways,” resulting in decreased hospital LOS, reduced stoma-related complications, and improved quality of life [31–33]. However, 2 systematic reviews on this topic demonstrated conflicting results: one concluded that structured patient education programs reduced hospital costs and improved quality of life [34], while the other found the use of educational interventions for new ostomates have limited evidence for improvement in clinical outcomes [35].…”

Section: Discussionmentioning

confidence: 99%

Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes

Tseng

Suidan

Zivanovic

et al. 2016

Gynecologic Oncology

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Objective To examine the use, as well as postoperative and long-term oncologic outcomes of diverting loop ileostomy (DI) during primary debulking surgery (PDS) for ovarian cancer. Methods Patients with stage II–IV ovarian, fallopian tube, or primary peritoneal carcinoma who underwent colon resection during PDS from 1/2005–1/2014 were identified. Demographic and clinical data were analyzed. Results Of 331 patients, 320 (97%) had stage III/IV disease and 278 (84%) had disease of high-grade serous histology. Forty-four (13%) underwent a DI. There were no significant differences in age, comorbidity index, smoking status, serum albumin, or attending surgeon between the DI and non-DI groups. Operative time (OR=1.21; 95% CI, 1.03–1.42; p=.02) and length of rectosigmoid resection (OR=1.04; 95% CI, 1.01–1.08; p=.02) were predictors of DI on multivariable analysis. The overall anastomotic leak rate was 6%. A comparison of groups (DI vs non-DI) showed no significant differences in major complications (30% vs 23%; p=.41), anastomotic leak rate (5% vs 7%; p=.60), hospital length of stay (10 vs 9 days; p=.25), readmission rate (23% vs 17%; p=.33), or interval to postoperative chemotherapy (41 vs 40 days; p=.20), respectively. Ileostomy reversal was successful in 89% of patients. Median follow-up was 52.6 months. There were no differences in median progression-free (17.9 vs 18.6 months; p=.88) and overall survival (48.7 vs 63.8 months; p=.25) between the groups. Conclusions In patients undergoing PDS, those with longer operative time and greater length of rectosigmoid resection more commonly underwent DI. DI does not appear to compromise postoperative outcomes or long-term survival.

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Section: Discussionmentioning

confidence: 99%

Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes

Tseng

Suidan

Zivanovic

et al. 2016

Gynecologic Oncology

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“…As a part of enhanced recovery programs, peri-operative stoma teaching reduces postoperative length of stay and complications, but has not been associated with an overall reduction in readmissions 8, 9 . Nagle and colleagues reported that an “ileostomy pathway” focused on patient self-management eliminated readmissions for dehydration, but did not significantly change readmission rates overall 6 .…”

Section: Introductionmentioning

confidence: 99%

Patient autonomy–centered self-care checklist reduces hospital readmissions after ileostomy creation

Hardiman

Reames

McLeod

et al. 2016

Surgery

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Background Patients who undergo colorectal surgery with new ileostomies incur high rates of readmission. Ostomates face a steep learning curve to master the skills and knowledge needed for success at home. We designed and implemented a patient-centered checklist promoting independence and validating self-care knowledge and care skills, and evaluated its effect on readmissions after ileostomy creation. Methods On a single inpatient unit, new ileostomy patients were taught and evaluated using a novel postoperative self-care checklist, while perioperative care for ostomates remained unchanged elsewhere in the institution. In a retrospective cohort including all consecutive ileostomy patients from two years before (Period 1) and one year after (Period 2) checklist implementation, we identified univariable predictors of readmission within 30 days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units. Results Of the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly higher All Patient Refined-Diagnosis Related Group weights (3.6 vs. 3.3, p=0.006), longer initial length of stay (13.3 vs. 11.3 days, p=0.006) and were more likely to be emergency admissions (49% vs. 38%, p=0.04). The readmission rate on the intervention unit decreased from 28% in Period 1 to 20% in Period 2. The logistic regression-based difference-in-differences approach revealed that implementation of the checklist was an independent negative predictor of readmission (p=0.04). Conclusion Implementation of a patient-centered, self-care oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation in colorectal surgery.

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“…In new patient groups entering an ERAS program, nutrition recommendations should be properly integrated into the guidelines to achieve an optimal preoperative status and to reduce perioperative complications, especially in malnourished patients. An important predictor for the success of an ERAS program is personalized counseling [112,113]. Patients undergoing esophagectomy incur significant psychological stress [114], and their individual disease perceptions are a larger determinant of psychological outcome than coping strategies [115], yet surgeons often fail to appreciate or address them [116].…”

Section: Enhanced Recovery After Surgery Programmentioning

confidence: 99%

Nutrition in peri-operative esophageal cancer management

Steenhagen

Vulpen

Hillegersberg

et al. 2017

Expert Review of Gastroenterology & Hepatology

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Introduction: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, perioperative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to longterm nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.ARTICLE HISTORY

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Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme

Abstract: Delayed discharge secondary to independent stoma management can be significantly reduced with preoperative stoma management teaching as part of an enhanced recovery programme.

Cited by 98 publications

References 22 publications

Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes

Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes

Patient autonomy–centered self-care checklist reduces hospital readmissions after ileostomy creation

Nutrition in peri-operative esophageal cancer management

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