Re‐admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre

Bhat, Sameer; O’Grady, Gregory; Bissett, Ian P.

doi:10.1111/ans.16076

Cited by 10 publications

(12 citation statements)

References 27 publications

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“…In the Liu article, 78 of 266 patients (29.3%) were readmitted within 60 days after ileostomy creation. Dehydration was observed in 26.9% (21 of 78) of cases and was the reason for readmission in 9.0% (7 of 78) 12 . These studies confirm older publications in which dehydration was present at the time of readmissions (17–50% of cases 13–18 ).…”

Section: Introductionsupporting

confidence: 81%

Hydration by colonic enteroclysis: An alternative to parenteral hydration in patients with high‐output double enterostomy

et al. 2021

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Background High‐output double enterostomies (DESs) result in sodium and fluid loss responsible for frequent episodes of dehydration and hospitalizations. Hydration by enteroclysis (HE) is an alternative to parenteral hydration when the small bowel, or the downstream colon, is accessible and functional. Methods A retrospective analysis was conducted on all consecutive patients admitted in our institution with high‐output (≥1200 ml per 24 h) DES and access to downstream intestine (including colon), who were treated by enteroclysis between 2015 and 2019. A sodium chloride and bicarbonate solution was instilled through a tube inserted in the colon. The objectives were diuresis >1 L, natriuresis >40 mmol/24 h, and urinary sodium‐to‐potassium ratio >1. Results HE was conducted in 52 patients (24 female, 28 male). Initially, 30 patients received intravenous support. Fifteen patients (50%) were weaned from all parenteral support, of whom 11 of 12 (92%) received fluid and electrolyte support and 4 of 18 (22%) received parenteral nutrition (PN). When intravenous fluids were still required, daily volumes decreased from 2714 ± 1424 to 1578 ± 1000 ml per 24 h (P = .001), as did the energetic intake (NS), from 1439 ± 556 to 1230 ± 362 kcal per 24 h (P = .096). Conclusion HE through the efferent intestine limits the requirement for parenteral hydration in patients with high‐output DES. For patients with intestinal failure dependent on PN, it reduces daily infused volumes.

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Section: Introductionsupporting

confidence: 81%

Hydration by colonic enteroclysis: An alternative to parenteral hydration in patients with high‐output double enterostomy

et al. 2021

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“…In a similar study, unplanned hospital readmission following ileostomy was 29%. Also, renal impairment at discharge was the most important risk factor to predict readmission [ 23 ]. In another recent study, Fielding et al found that postoperative renal impairment more frequently occurred in patients with a diverting ileostomy.…”

Section: Discussionmentioning

confidence: 99%

Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel?

Butsele¹,

Bislenghi²,

D’Hoore³

et al. 2021

BMC Surg

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Background Rectal resection surgery is often followed by a loop ileostomy creation. Despite improvements in surgical technique and development of enhanced recovery after surgery (ERAS) protocols, the readmission-rate after rectal resection is still estimated to be around 30%. The purpose of this study was to identify risk factors for readmission after rectal resection surgery. This study also investigated whether elderly patients (≥ 65 years old) dispose of a distinct patient profile and associated risk factors for readmission. Methods This is a retrospective study of prospectively collected data from patients who consecutively underwent rectal resection for cancer within an ERAS protocol between 2011 and 2016. The primary study endpoint was 90-day readmission. Patients with and without readmission within 90 days were compared. Additional subgroup analysis was performed in patients ≥ 65 years old. Results A total of 344 patients were included, and 25% (n = 85) were readmitted. Main reasons for readmission were acute renal insufficiency (24%), small bowel obstruction (20%), anastomotic leakage (15%) and high output stoma (11%). In multivariate logistic regression, elevated initial creatinine level (cut-off values: 0.67–1.17 mg/dl) (OR 1.95, p = 0.041) and neoadjuvant radiotherapy (OR 2.63, p = 0.031) were significantly associated with readmission. For ileostomy related problems, elevated initial creatinine level (OR 2.76, p = 0.021) was identified to be significant. Conclusion Recovery after rectal resection within an ERAS protocol is hampered by the presence of a loop ileostomy. ERAS protocols should include stoma education and high output stoma prevention.

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“…Readmission within 60 days of ileostomy creation was reported in 6 studies [3,22,32,39,49,67]. Dehydration led to readmission in 10% (95% CI 0.08-0.12, I 2 = 39%, τ 2 = 0.02 p = 0.14), with the pooled proportion of all-cause readmission being 27% (95% CI 0.21-0.34, I 2 = 88%, τ 2 = 0.15 p < 0.01) (Figures S3, S4).…”

Section: Readmission With 60 Daysmentioning

confidence: 99%

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

et al. 2022

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Background Hospital readmissions after creation of an ileostomy are common and come with a high clinical and financial burden. The aim of this review with pooled analysis was to determine the incidence of dehydration-related and all-cause readmissions after formation of an ileostomy, and the associated costs. Methods A systematic literature search was conducted for studies reporting on dehydration-related and overall readmission rates after formation of a loop or end ileostomy between January 1990 and April 2021. Analyses were performed using R Statistical Software Version 3.6.1. Results The search yielded 71 studies (n = 82,451 patients). The pooled incidence of readmissions due to dehydration was 6% (95% CI 0.04–0.09) within 30 days, with an all-cause readmission rate of 20% (CI 95% 0.18–0.23). Duration of readmissions for dehydration ranged from 2.5 to 9 days. Average costs of dehydration-related readmission were between $2750 and $5924 per patient. Other indications for readmission within 30 days were specified in 15 studies, with a pooled incidence of 5% (95% CI 0.02–0.14) for dehydration, 4% (95% CI 0.02–0.08) for stoma outlet problems, and 4% (95% CI 0.02–0.09) for infections. Conclusions One in five patients are readmitted with a stoma-related complication within 30 days of creation of an ileostomy. Dehydration is the leading cause for these readmissions, occurring in 6% of all patients within 30 days. This comes with high health care cost for a potentially avoidable cause. Better monitoring, patient awareness and preventive measures are required.

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Re‐admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre

Cited by 10 publications

References 27 publications

Hydration by colonic enteroclysis: An alternative to parenteral hydration in patients with high‐output double enterostomy

Hydration by colonic enteroclysis: An alternative to parenteral hydration in patients with high‐output double enterostomy

Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel?

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

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