Hospital Readmission for Fluid and Electrolyte Abnormalities Following Ileostomy Construction: Preventable or Unpredictable?

• Published in: Journal of gastrointestinal surgery 2013-02, Vol.17 (2), p.298-303
• Main Authors: Hayden, Dana M., Pinzon, Maria C. Mora, Francescatti, Amanda B., Edquist, Sarah C., Malczewski, Matthew R., Jolley, Jennifer M., Brand, Marc I., Saclarides, Theodore J.
• Format: Article
• Language: English
• Subjects: 2012 SSAT Quick Shot Presentation; Adolescent; Adult; Aged; Aged, 80 and over; Body Fluids; Body mass index; Cancer therapies; Chemotherapy; Colorectal cancer; Creatinine; Data collection; Electrolytes; Emergency medical care; Female; Gastroenterology; Hospitals; Humans; Ileostomy - adverse effects; Inflammatory bowel disease; Intestinal obstruction; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Ostomy; Patient Readmission - statistics & numerical data; Radiation; Retrospective Studies; Surgery; Surgical anastomosis; Water-Electrolyte Imbalance - etiology; Water-Electrolyte Imbalance - prevention & control; Young Adult
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-012-2073-5

Background Ileostomy creation has complications, including rehospitalization for fluid and electrolyte abnormalities. Although studies have identified predictors of this morbidity, readmission rates remain high. Methods The researchers conducted a retrospective chart review of all patients with ileostomy creation at a tertiary institution from January 2008 to June 2011. Results One hundred fifty-four patients (154) were included in this study; 71 (46.1 %) were female. Mean age was 49 ± 17.64 (range 16–91), and mean BMI was 26.9 ± 6.44 (range 13–52). The readmission rate for fluid and electrolyte abnormalities was 20.1 % for the study population; of those readmitted for all diagnoses, dehydration accounted for 40.7 % of all readmissions. Cancer was associated with readmission ( χ 2  = 4.73, p  = 0.03) as was neoadjuvant therapy ( χ 2  = 9.20, p  = 0.01). After multivariate analysis, only the use of anti-diarrheals and neoadjuvant therapy remained significant. High stoma output, adjuvant treatment, and postoperative complications were not significant. Conclusions Our study found that the use of anti-diarrheals and neoadjuvant therapy for rectal cancer were associated with readmission. Our findings imply that the use of anti-diarrheals may be a marker for patients at risk for fluid and electrolyte abnormalities; these patients should be strictly monitored at home. Our study also suggests consideration of avoidance of ileostomy creation or different discharge criteria for at-risk patients. Prospective studies focused on stoma monitoring after discharge may help reduce rehospitalizations for fluid and electrolyte abnormalities after ileostomy creation.