The Impact of an Enhanced Recovery Program on Loop Ileostomy Closure

Abstract

Background The implementation of enhanced recovery after surgery (ERAS) protocols has decreased the length of stay (LOS) and complications in colorectal procedures. However, little data has been published on the subset of patients undergoing loop ileostomy closure. We investigated the outcomes of loop ileostomy reversals prior to and after initiation of an ERAS protocol. Methods Patients undergoing ileostomy reversal over a 5-year period by 4 colorectal surgeons were studied and divided into pre-ERAS patients and ERAS patients in a retrospective, case-control study. Patient demographics, comorbidities, LOS, underlying disease process, index intra-abdominal procedure, readmission rate, and complications were evaluated. Results Overall, 208 patients were analyzed 149 pre-ERAS and 59 ERAS–with median LOS significantly lower in the ERAS group than the pre-ERAS group (50.8 hours vs. 96.1 hours, P < .0001). In subgroup analysis, the LOS was significantly lower if the index procedure performed was laparoscopic when comparing ERAS to pre-ERAS (49.9 hours vs. 96.6 hours, P < .001). ERAS did not confer a significant decrease in the LOS during ileostomy reversal with open index procedures (72.9 hours vs. 95.5 hours, P = .05). Conclusion Utilizing an ERAS protocol is safe and effective for loop ileostomy closure with a shorter LOS and no difference in complication rates or 30-day readmission rates.

Decreasing Readmissions After Ileostomy Creation Through a Perioperative Quality Improvement Program

“…Although our 30-day dehydration-related readmission rate compared to NSQIP data was similar, 3.75% is lower than what is reported in the literature. [5][6][7]18 Chen et al 9 mentioned that the relatively lower dehydration readmission rate from NSQIP data might be due to misidentification of dehydration readmissions by International Classification of Diseases, 9th revision and 10th revision codes. Also‚ the true incidence of dehydration may be underreported, as NSQIP only captures single International Classification of Diseases readmission diagnoses.…”

“…However, 30-day readmission after ileostomy creation in patients undergoing colorectal surgery remains as high as 43% and has not decreased due to the implementation of ERAS. [5][6][7] Ileostomies are created either temporarily or permanently in certain conditions‚ such as colorectal cancer, IBD, or other conditions necessitating fecal diversion. There are several causes of readmission after ileostomy creation, including dehydration, acute kidney injury, and intra-or extraperitoneal infections.…”

“…However, 30-day readmission after ileostomy creation in patients undergoing colorectal surgery remains as high as 43% and has not decreased due to the implementation of ERAS. 5–7…”