The Relationship Between High-Output Stomas, Postoperative Ileus, and Readmission After Rectal Cancer Surgery With Diverting Ileostomy

Abstract

This study aimed to evaluate the relationship between high-output stomas (HOSs), postoperative ileus (POI), and readmission after rectal cancer surgery with diverting ileostomy. Methods: We included 302 patients with rectal cancer who underwent restorative resection with diverting ileostomy between January 2011 and December 2015. HOSs were defined as stomas with ≥2000 mL/day output. We analyzed predictive factors for readmission of these patients. Results: Forty-eight (15.9%) patients had HOSs during the hospital stay, and 41 (13.6%) patients experienced POI. HOSs were strongly associated with POI (45.8 vs. 7.5%, p<0.001). The all-cause readmission rate was 16.9%, with 19 (6.3%) and 20 (6.6%) patients experiencing ileus and acute kidney injury, respectively. HOSs (27.1 vs. 15.0%, p=0.040) and POI (34.1 vs. 14.2%, p=0.002) were associated with all-cause readmission, and POI was associated with readmission with ileus (17.1 vs. 4.6%, p=0.007). POI was an independent risk factor for all-cause readmission (adjusted odds ratio [OR]=2.640; 95% confidence interval [CI] 1.162-6.001; p=0.020) and readmission with ileus (adjusted OR=3.869; 95% CI 1.387-10.792; p=0.010). Conclusions: POI was associated with readmission, particularly for subsequent ileus, in patients with diverting ileostomy. We should make efforts to reduce POI, such as strong control of HOSs, to prevent readmission.

Postoperative paralytic ileus following debulking surgery in ovarian cancer patients

“…Diverting ileostomies may reduce the clinical severity of anastomotic leakage, but no reduction of leakages is seen in the case of rectal cancer, remaining a controversial topic ( 40 ). Especially high output diverting ileostomies are suspected to be at risk for POI, readmission, and subsequent ileus ( 40 ). In ovarian cancer, anastomoses are generally 3 cm–5 cm higher than in rectal cancer.…”

The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery

“…Furthermore, older patients exhibited a high incidence of postoperative ileus and a relatively high rate of stoma formation. These conditions can be associated with high output and may increase the likelihood of low adherence to the ERAS protocol [39].…”

Obstructive and secretory complications of diverting ileostomy

“…The incidence of HOS varies from 14% to 24%[ 29 , 41 - 43 ] with various definitions. 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 ].…”

“…The causes of HOS are multifactorial, including factors associated with patients[ 42 , 48 ], disease[ 29 , 42 , 43 ], anatomy[ 29 ], surgical procedure[ 29 , 42 , 43 , 48 ], medication[ 29 , 33 ], nutrition[ 29 ], enteritis/metabolism[ 29 , 39 ] and those related to postoperative complications[ 29 , 44 , 49 ]. Older age was identified as an independent risk factor of HOS in two studies: however, the cut-off values were not shown because the comparisons were made without dichotomization in their studies[ 42 , 48 ].…”

“…Postoperative complications may induce secondary HOS, including prolonged ileus[ 44 ] (presented with nausea, vomiting, intolerance to oral feeding, abdominal distension, or failure to pass flatus or bowel movements within postoperative 7 d), SBO[ 29 ], SOO/SRO[ 49 ], or intra-abdominal sepsis/deep surgical site infection[ 29 , 49 ]. These postoperative complications must be excluded clinically and radiologically when suspicious of HOS.…”