Dehydration Is the Most Common Indication for Readmission After Diverting Ileostomy Creation
- 1 February 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 55 (2), 175-180
- https://doi.org/10.1097/dcr.0b013e31823d0ec5
Abstract
Early readmission after discharge from the hospital is an undesirable outcome. Ileostomies are commonly used to prevent symptomatic anastomotic complications in colorectal resections. The aim of this study was to identify factors predictive of readmission after colectomy/proctectomy and diverting loop ileostomy. This study is a retrospective review. Patients were included who underwent colon and rectal resections with ileostomy at our institution. Sex, age, type of disease, comorbidities, elective vs urgent procedure, type of ileostomy, operative method, steroid use, ASA score, and the use of diuretics were evaluated as potential factors for readmission. The primary outcomes measured were the need for readmission and the presence of dehydration (ostomy output ≥1500 mL over 24 hours and a blood urea nitrogen/creatinine level ≥20, or physical findings of dehydration). Six hundred three loop ileostomies were created mostly in white (95.3%), male (55.6%) patients undergoing colon or rectal resections. IBD was the most common indication at 50.9%, with rectal cancer at 16.1%, and other at 31.0%. The 60-day readmission rate was 16.9% (n = 102) with the most common cause dehydration (n = 44, 43.1%). Regression analysis demonstrated that the laparoscopic approach (p = 0.02), lack of epidural anesthesia (p = 0.004), preoperative use of steroids (p = 0.04), and postoperative use of diuretics (p = 0.0001) were highly predictive for readmission. Furthermore, regression analysis for readmission for dehydration identified the use of postoperative diuretics as the sole risk factor (p = 0.0001). This study is limited by the retrospective analysis of data, and it does not capture patients that were treated at home or in clinic. Readmission after colon or rectal resection with diverting loop ileostomy was high at 16.9%. Dehydration was the major cause for readmission. Patients receiving diuretics are at increased risk for readmission for dehydration. High-risk patients should be treated more cautiously as inpatients and closely monitored in the outpatient setting to help reduce dehydration and readmission.Keywords
This publication has 16 references indexed in Scilit:
- Early Readmission After Ileoanal Pouch SurgeryDiseases of the Colon & Rectum, 2009
- Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysisInternational Journal of Colorectal Disease, 2009
- Systematic Review and Meta-Analysis of the Role of Defunctioning Stoma in Low Rectal Cancer SurgeryAnnals of Surgery, 2008
- Comparison of Outcomes After Restorative Proctocolectomy With or Without Defunctioning IleostomyArchives of Surgery, 2008
- Parastomal HerniasSurgical Clinics of North America, 2008
- Risk Factors of Unplanned Readmission After Colorectal Surgery: A Prospective, Multicenter StudyDiseases of the Colon & Rectum, 2007
- Multivariable analysis of factors associated with hospital readmission after intestinal surgeryThe American Journal of Surgery, 2006
- Small bowel obstruction following low anterior resection: the impact of diversion ileostomyLangenbecks Archives Of Surgery, 2004
- Prospective, Randomized, Controlled Trial Between a Pathway of Controlled Rehabilitation With Early Ambulation and Diet and Traditional Postoperative Care After Laparotomy and Intestinal ResectionDiseases of the Colon & Rectum, 2003
- A Clinical Pathway to Accelerate Recovery After Colonic ResectionAnnals of Surgery, 2000