Interventions to reduce dehydration related to defunctioning loop ileostomy after low anterior resection in rectal cancer: a prospective cohort study

Munshi, Eihab; Bengtsson, Eva; Blomberg, Karin; Syk, Ingvar; Buchwald, Pamela

doi:10.1111/ans.16258

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…126 Meanwhile, other studies have reported that ileostomy pathways do not decrease readmission rates. 122,131,132 In an RCT of 100 patients who either received an ileostomy education and monitoring program or received routine postoperative care, intervention patients were more likely to require outpatient intravenous fluids (25% versus 6%; p = 0.008), and there were no differences between the 2 groups in overall hospital readmissions (20.4% versus 19.6%; p = 1.0), readmissions for dehydration (8.2% versus 5.9%; p = 0.71), and patients developing acute renal failure (10.2% versus 3.9%; p = 0.26). Multivariable analysis found that weekend discharges to home were significantly associated with readmission (OR, 4.5; 95% CI, 1.2-16.9).…”

Section: Managing Patients With a New Ileostomy With A Perioperative ...mentioning

confidence: 99%

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

Davis

Valente

Goldberg

et al. 2022

Diseases of the Colon &Amp; Rectum

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Section: Managing Patients With a New Ileostomy With A Perioperative ...mentioning

confidence: 99%

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

Davis

Valente

Goldberg

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…Previous studies have identified risk factors associated with readmission attributed to dehydration: age ≥65 years, obesity, IPAA creation, hypertension, renal insufficiency, female sex, higher ASA class, emergency case, postoperative complications including sepsis and surgical site infections, discharge to skilled facility, or shortened length of stay in the hospital. [9][10][11][12][13] Readmissions impose a significant burden on the health care cost and patient quality of care. Other issues related to readmission include the challenges of self-care for a new ileostomy after discharge and the significant impact that an ileostomy has on a patient's lifestyle.…”

Section: Conclusionesmentioning

confidence: 99%

Decreasing Readmissions After Ileostomy Creation Through a Perioperative Quality Improvement Program

Hsu

Crawford

Safar

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Readmission after ileostomy creation in patients undergoing colorectal surgery creates a significant burden on health care cost and patient quality of care, with a 30-day readmission rate of 40%. OBJECTIVE: This study aimed to evaluate the implementation of our perioperative quality improvement program, Decreasing Readmissions After Ileostomy Creation. DESIGN: Perioperative interventions were administered to patients who underwent ileostomy creation. SETTINGS: A single tertiary care academic center. PATIENTS: Eighty patients participated in this program from February 2020 to January 2021. MAIN OUTCOME MEASURES:The primary outcomes measured were 30-day readmission rates and causes of readmission, which were compared to a historical national database. Descriptive statistics were used to evaluate the effectiveness of this quality improvement program.RESULTS: Eighty patients were enrolled in this prospective quality improvement program. The mean age was 52 (±15.06) years. The most common indication for patients undergoing creation of an ileostomy was colorectal cancer (40%; n = 32). The overall 30-day readmission rate was 8.75% (n = 7) throughout the study period, which was significantly lower than historical cohort data (20.10%; p = 0.01). Among the 7 readmitted patients, 3 (3.75%) were readmitted due to dehydration. The most significant associated risk factor for all-cause readmission was urgent/emergent operative status, which was associated with an increased risk of readmission (p = 0.01). The 3 readmitted patients with dehydration had a mean Dehydration Readmission After Ileostomy Prediction risk score of 11.71 points, compared to 9.59 points in nondehydrated patients, who did not require readmission (p = 0.38).LIMITATIONS: This study is limited by its small sample size (N = 80). CONCLUSIONS:The Decreasing Readmissions After Ileostomy Creation program has been successful in reducing both the all-cause readmission rate and readmission due to dehydration both within an academic tertiary care referral center and in comparison with historical readmission rates.

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“…The local and systemic physiological changes due to DLI can vary from minor symptoms of skin irritation and leakage (59%) to significant issues like dehydration, obstruction, and parastomal hernia (25%) [ 14 ]. One-third of DLI patients risk dehydration in the first six weeks, and half of them require admission for electrolytes correction, possibly putting adjuvant chemotherapy at stake [ 15 ]. DLI also impairs health-related quality of life [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage: a national population-based cohort study

2023

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Background Anterior resection (AR) is considered the gold standard for curative cancer treatment in the middle and upper rectum. The goal of the sphincter-preserving procedure, such as AR, is vulnerable to anastomotic leak (AL) complications. Defunctioning stoma (DS) became the protective measure against AL. Often a defunctioning loop-ileostomy is used, which is associated with substantial morbidity. However, not much is known if the routine use of DS reduces the overall incidence of AL. Methods Elective patients subjected to AR in 2007–2009 and 2016-18 were recruited from the Swedish colorectal cancer registry (SCRCR). Patient characteristics, including DS status and occurrence of AL, were analyzed. In addition, independent risk factors for AL were investigated by multivariable regression. Results The statistical increase of DS from 71.6% in 2007–2009 to 76.7% in 2016–2018 did not impact the incidence of AL (9.2% and 8.2%), respectively. DLI was constructed in more than 35% of high-located tumors ≥ 11 cm from the anal verge. Multivariable analysis showed that male gender, ASA 3–4, BMI > 30 kg/m2, and neoadjuvant therapy were independent risk factors for AL. Conclusion Routine DS did not decrease overall AL after AR. A selective decision algorithm for DS construction is needed to protect from AL and mitigate DS morbidities.

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Interventions to reduce dehydration related to defunctioning loop ileostomy after low anterior resection in rectal cancer: a prospective cohort study

Cited by 8 publications

References 24 publications

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

Decreasing Readmissions After Ileostomy Creation Through a Perioperative Quality Improvement Program

Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage: a national population-based cohort study

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