Overall readmissions and readmissions related to dehydration after creation of an ileostomy: a systematic review and meta-analysis

Vogel, Irene; Shinkwin, M.; Storm, Seneca; Torkington, Jared; Cornish, Julie; Tanis, Pieter J.; Hompes, Roel; Bemelman, W. A.

doi:10.1007/s10151-022-02580-6

Cited by 32 publications

(24 citation statements)

References 72 publications

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“…Our study aims to fill this gap in the literature, and the collaborative nature of this multicentre study, will allow capturing real-world data on the current use of stomas in patients with CD and on the complications related to the stoma formation and reversal. One in five patients are readmitted with a stoma-related complication within 30 days of the creation of an ileostomy, with dehydration being the leading cause, occurring in 6% of patients [ 16 ]. The rate of stoma-related complications will likely be higher during the 18-months follow-up of our study, reflecting the high health care cost for a potentially avoidable cause, including long-term complications, which often require further surgery or contribute to mortality [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The INTESTINE study: INtended TEmporary STomas In crohN’s diseasE. Protocol for an international multicentre study

et al. 2022

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Surgery for ileocolonic Crohn’s disease can result in temporary or permanent stoma formation which can be associated with morbidity as parastomal and incisional hernias, readmissions due to obstruction or high stoma output, and have a negative impact on quality of life. We propose an international retrospective trainee-led study of the outcomes of temporary stomas in patients with Crohn’s disease. We aim to evaluate both the short-term (6 month) and mid-term (18 month) outcomes of temporary stomas in patients with Crohn’s Disease. Retrospective, multicentre, observational study including all patients who underwent elective or emergency surgery for ileal, colonic and ileocolonic Crohn’s disease during a 4-year study period. Primary outcome is the proportion of patients who still have an ileostomy or colostomy 18 months after the initial surgery. Secondary outcomes: complications related to stoma formation and stoma reversal surgery; time interval between stoma formation and stoma reversal; risk factors for stoma formation and non-reversal of the stoma. We present the study protocol for a trainee-led, multicentre, observational study. Previous research has demonstrated significant heterogeneity surrounding the formation and the timing of reversal surgery in patients having a temporary ileostomy following colorectal cancer surgery, highlighting the need to address these same questions in Crohn’s disease, which is the aim of our research.

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Section: Discussionmentioning

confidence: 99%

The INTESTINE study: INtended TEmporary STomas In crohN’s diseasE. Protocol for an international multicentre study

et al. 2022

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“…Dehydration has been shown to be a cause of readmission in 9.3%-43% of the patients after ileostomy creation without preventive protocols[ 33 - 35 ]. The most recent meta-analysis showed that the pooled incidence of readmission due to dehydration was 6% regardless of HOS prevention and was accompanied by increased medical costs[ 36 ]. Moreover, HOS results in electrolyte imbalance and acute kidney injury in the early postoperative period and may lead to malnutrition and chronic renal impairment in the long term[ 30 , 37 ].…”

Section: Secretory Complication (High Output)mentioning

confidence: 99%

“…The majority of previous reports have defined using specific values of output volume with a timeframe, such as 2000 mL per day[ 38 , 44 , 45 ], 1500 mL per day for two days[ 41 ], 1000 mL per day for three days[ 42 , 46 ], and 2000 mL per day for three days[ 29 , 43 ]. Some authors have used a combination of output volume with laboratory findings of renal impairment and/or physical signs of dehydration[ 36 , 47 ].…”

Section: Secretory Complication (High Output)mentioning

confidence: 99%

Obstructive and secretory complications of diverting ileostomy

Tsujinaka¹,

Suzuki²,

Miura³

et al. 2022

World J Gastroenterol

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This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.

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“…A 2022 meta‐analysis showed that one in five patients were readmitted with a stoma‐related complication within 30 days of ileostomy creation. Dehydration from high stomal output was the most frequent complication, occurring in 6% of patients and resulting in additional costs of $2750 to $5924 per patient 6 …”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the time between stoma creation and closure can be considerable, 6 increasing the risk of additional complications, including stomal outlet and peristomal skin irritation issues. A 2016 study showed a more than 8‐month mean interval between LAR and DI reversal, with a further 17% morbidity rate following DI reversal 7 .…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer

Shannon

Seow‐En

Tan

2022

ANZ Journal of Surgery

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Background Following ultralow anterior resection for distal rectal cancers, a coloanal anastomosis is usually created along with a defunctioning ileostomy (DI). Recent evidence suggests that abdominoperineal pull‐through with delayed coloanal anastomosis (DCAA) is a viable alternative to immediate coloanal anastomosis (ICAA), minimizing the risk of anastomotic leakage and avoiding the need for stoma creation with the risk of stoma‐associated morbidity. However, DCAA requires a longer initial hospitalization. We aimed to perform a cost‐effectiveness analysis to compare DCAA versus ICAA for elective rectal cancer surgery. Methods A decision tree model was used to compare the cost‐effectiveness of the two strategies. Cost data were obtained from the 2019 to 2020 United Kingdom National Health Service reference costs. Model probabilities were derived from published studies. Univariate and probabilistic sensitivity analyses were used to evaluate the robustness of the results. Results DCAA was the overall cheaper strategy at £13 541 compared with £14 856 for ICAA in the base case analysis. This was explained by the decreased overall costs of hospitalization/surgery, reduction in costs associated with anastomotic or stoma‐related complications, specifically dehydration‐induced hospital readmissions and avoidance of stoma maintenance costs. Sensitivity analysis demonstrated that DCAA remained consistently more inexpensive except when the duration of total parenteral nutrition exceeded 14 days. Conclusion Despite a longer index hospitalization with higher initial costs, this economic analysis demonstrates that DCAA without stoma is overall more cost‐effective compared with ICAA with DI following ultralow anterior resection. Cost savings should be considered an additional benefit when selecting the DCAA approach for rectal cancer surgery.

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Overall readmissions and readmissions related to dehydration after creation of an ileostomy: a systematic review and meta-analysis

Cited by 32 publications

References 72 publications

The INTESTINE study: INtended TEmporary STomas In crohN’s diseasE. Protocol for an international multicentre study

The INTESTINE study: INtended TEmporary STomas In crohN’s diseasE. Protocol for an international multicentre study

Obstructive and secretory complications of diverting ileostomy

Cost‐effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer

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