Readmissions after ileostomy closure: cause to revisit a standardized enhanced recovery pathway?

Abstract Background Our objective was to evaluate ileostomy reversal patients managed with a standardized enhanced recovery pathway to identify factors associated with readmissions. Methods Prospective review database identified ileostomy reversal patients. Variables for the index admission and read...

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Bibliographic Details
Published in:The American journal of surgery 2014-10, Vol.208 (4), p.650-655
Main Authors: Keller, Deborah S., M.S., M.D, Swendseid, Brian, B.S, Khan, Sadaf, M.D, Delaney, Conor P., M.D., M.Ch., Ph.D., F.R.C.S.I., F.A.C.S., F.A.S.C.R.S
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Aged, 80 and over
Anastomosis, Surgical - methods
Blood
Body mass index
Clinical outcomes
Colorectal surgery
Critical Pathways - standards
Enhanced recovery pathways
Female
Follow-Up Studies
Hospitals
Humans
Ileostomy
Ileum - physiology
Ileum - surgery
Inflammatory bowel disease
Laparoscopy
Length of Stay - trends
Male
Medical personnel
Medical records
Middle Aged
Mortality
Nitrogen
Ostomy
Patient outcomes
Patient Readmission - trends
Postoperative Care - methods
Prospective Studies
Readmission rates
Recovery of Function
Standard deviation
Surgery
Treatment Outcome
Young Adult
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Summary:Abstract Background Our objective was to evaluate ileostomy reversal patients managed with a standardized enhanced recovery pathway to identify factors associated with readmissions. Methods Prospective review database identified ileostomy reversal patients. Variables for the index admission and readmission were evaluated. Results Three hundred thirty-two patients were analyzed. The primary diagnosis was colorectal cancer (57.6%). Thirteen percent of the patients were discharged by postoperative day (POD) 1, 47% by POD 2, and 65% by POD 3. The complication rate was 16.8%. The main complication was ileus/small bowel obstruction ( n = 27). Thirty-day readmission rate was 12.4% ( n = 41); small bowel obstruction ( n = 27) was the most frequent readmission diagnosis. The median readmission POD was 7. Only 1 patient had a follow-up visit before readmission. The median readmission length of stay was 4 days. Conclusions Most ileostomy reversal readmissions occur before the first follow-up and stem from preventable causes. An enhanced recovery pathway modification may improve outcomes and utilization in this group.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2014.05.003