Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long?

Baraza, Wal; Wild, Jonathan; Barber, W. Howard; Brown, Steven R.

doi:10.1308/003588410x12518836439209

Cited by 40 publications

(22 citation statements)

References 13 publications

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“…Closure of ileostomy is being advocated as early as two weeks; to avoid complications of ileostomy may not be ideal in these patients [30,31]. Early second surgery would increase the surgical stress on these patient, and a more delayed reversal could only prolong the morbidity.…”

Section: Discussionmentioning

confidence: 99%

Challenges of Managing Emergency Ileostomy: Nutrition—A Neglected Aspect

Mohil

Narayan

Sreenivas

et al. 2012

ISRN Emergency Medicine

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Objective. The present study was carried out with an aim to study the nutritional status of patients undergoing emergency ileostomy using simple bedside tools in a developing country. Methods. Nutritional assessment (anthropometry, biochemical, immunological, and dietary) was done within 24-36 hours of admission and 6 weeks postoperatively. Primary endpoint was the study of the nutritional status of the patients with ileostomy. Results. N = 58, 47 males with mean age 32 years. Postoperatively 50 (86.2%) patients experienced some complications including those related to ileostomy. Malnutrition varied from 7 (12.1%) using BMI to 54 (93.1%) by triceps skinfold thickness. At 6 weeks, despite adequate nutritional intake, there was a significant decrease in almost all nutritional parameters except serum albumin which was normal in most patients. Factors contributing to weight loss in 41 (70.7%) patients were decreased length of proximal bowel left (P = 0.001), increased ileostomy output (P = 0.001), delayed surgery (P = 0.004), and increased disease severity score (P = 0.005). Conclusion. Majority of patients undergoing emergency ileostomy were malnourished and had significant nutritional depletion despite adequate nutritional support. Serial assessment helps to assess nutritional recovery in these patients.

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Section: Discussionmentioning

confidence: 99%

Challenges of Managing Emergency Ileostomy: Nutrition—A Neglected Aspect

Mohil

Narayan

Sreenivas

et al. 2012

ISRN Emergency Medicine

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“…These reasons could be evaluated and lessons learned [86] • Early discharge planning [40] • Taking care of aftercare: calling all patients a day after they have been discharged or close nursing follow-up [87][88][89] • Accelerating discharge [47]. The transfer to health care facilities receiving the patient can often be carried out more swiftly [5] and some hospital-related care can be given at home [90][91][92] or with more support in the community [93] Gap 1: Evidence-based interventions found in literature, but not proposed by the professionals:…”

Section: Matches Between Interventions Proposed By the Professionals mentioning

confidence: 99%

Fifty ways to reduce length of stay: An inventory of how hospital staff would reduce the length of stay in their hospital

Borghans

Kool

Lagoe³

et al. 2012

Health Policy

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“…GI motility complications (including postoperative ileus and intestinal obstruction or small bowel obstruction) are among the most frequent complications of ileostomy reversal, with reported rates of 5%–12% 11–17,19,20. Perioperative opioid use is likely to exacerbate the burden of GI motility and other complications 4–6,8.…”

Section: Introductionmentioning

confidence: 99%

An extended paIn relief trial utilizing the infiltration of a long-acting Multivesicular liPosome foRmulation Of bupiVacaine, EXPAREL (IMPROVE): a Phase IV health economic trial in adult patients undergoing ileostomy reversal

Marcet¹,

Nfonsam²,

Larach³

2013

JPR

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BackgroundOpioid analgesics are effective for postsurgical pain but are associated with opioid-related adverse events, creating a significant clinical and economic burden. Gastrointestinal surgery patients are at high risk for opioid-related adverse events. We conducted a study to assess the impact of an opioid-sparing multimodal analgesia regimen with liposome bupivacaine, compared with the standard of care (intravenous [IV] opioid-based, patient-controlled analgesia [PCA]) on postsurgical opioid use and health economic outcomes in patients undergoing ileostomy reversal.MethodsIn this open-label, multicenter study, sequential cohorts of patients undergoing ileostomy reversal received IV opioid PCA (first cohort); or multimodal analgesia including a single intraoperative administration of liposome bupivacaine (second cohort). Rescue analgesia was available to all patients. Primary outcome measures were postsurgical opioid use, hospital length of stay, and hospitalization costs. Incidence of opioid-related adverse events was also assessed.ResultsTwenty-seven patients were enrolled, underwent the planned surgery, and did not meet any intraoperative exclusion criteria; 16 received liposome bupivacaine-based multimodal analgesia and eleven received the standard IV opioid PCA regimen. The multimodal regimen was associated with significant reductions in opioid use compared with the IV opioid PCA regimen (mean, 20 mg versus 112 mg; median, 6 mg versus 48 mg, respectively; P < 0.01), postsurgical length of stay (median, 3.0 days versus 5.1 days, respectively; P < 0.001), and hospitalization costs (geometric mean, $6482 versus $9282, respectively; P = 0.01).ConclusionA liposome bupivacaine-based multimodal analgesic regimen resulted in statistically significant and clinically meaningful reductions in opioid consumption, shorter length of stay, and lower inpatient costs than an IV opioid-based analgesic regimen.

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Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long?

Abstract: The majority of patients undergoing loop ileostomy reversal at our institution can be discharged earlier than they are at present. Support in the community and the implementation of modified UK day-case surgery protocols are suggested to help shorten patients' length of stay.

Cited by 40 publications

References 13 publications

Challenges of Managing Emergency Ileostomy: Nutrition—A Neglected Aspect

Challenges of Managing Emergency Ileostomy: Nutrition—A Neglected Aspect

Fifty ways to reduce length of stay: An inventory of how hospital staff would reduce the length of stay in their hospital

An extended paIn relief trial utilizing the infiltration of a long-acting Multivesicular liPosome foRmulation Of bupiVacaine, EXPAREL (IMPROVE): a Phase IV health economic trial in adult patients undergoing ileostomy reversal

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