BACKGROUND 29% of post-ileostomy discharges are readmitted, most commonly due to dehydration. However, there is a lack of detailed data specifically evaluating factors associated with readmission with dehydration. Additionally, patients with a history of an ileostomy have often been excluded from previous studies, and therefore represent a group of understudied ileostomates. OBJECTIVE To evaluate factors available at discharge associated with 30-day readmission for dehydration, rather than all-cause readmissions. DESIGN This was a retrospective cohort study. SETTING Study patients received ileostomies at a tertiary academic medical center from 2014–2016. PATIENTS Patients with a pre-existing ileostomy which was not recreated per the operative note were excluded, while those who received a new ileostomy were included. MAIN OUTCOME MEASURE 30-day readmission for dehydration as defined by objective clinical criteria. RESULTS A total of 262 patients underwent ileostomy creation and were discharged alive. 25% were aged ≥65, 53% were male, 14% had a history of ileostomy, 18% had a creatinine >1.0 on discharge, and 26% had high ileostomy output at any time during the index admission. Among all ileostomates, the all-cause rate was 30%. Mean days to readmission for any cause was 8.5 while for dehydration it was 11.6 days. Of the readmissions, 37% were readmitted with a diagnosis of dehydration, and dehydration was the sole reason in 26%. Among those with dehydration, the most common length of stay was 2 days. In multivariable logistic regression, 30-day readmission with dehydration was associated with older age, male sex, history of an ileostomy, high ileostomy output during index admission, and a discharge creatinine >1.0. LIMITATIONS Retrospective design. CONCLUSIONS Ileostomy dehydration efforts have focused on new ileostomy patients; however, our data suggests that patients with a history of an ileostomy are actually at risk for readmission with dehydration. Further studies aimed at reduction of readmission with dehydration after ileostomy are warranted and should include patients with a history of an ileostomy. See Video Abstract at http://links.lww.com/DCR/A643.

Our results indicate that when controlled for patient, tumor, and hospital factors, patients who traveled a long distance to a high-volume center had improved lymph node yield, neoadjuvant chemoradiation receipt, and 30- and 90-day mortality compared with those who traveled a short distance to a low-volume center. They also had improved 5-year survival. See Video Abstract at http://links.lww.com/DCR/A446.

Emergent resection for colon cancer is independently associated with poor short-term outcomes and decreased 5-year OS compared to elective resection. With 30% of cases in this study emergent, these findings underlie the importance of adherence to colon cancer screening guidelines to limit the need for emergent resections.

Although nonelective IBD surgery rates have remained stable, associated 30-day mortality for UC has doubled in recent years despite advances in medical management. Current clinical decision-making and care pathways must be further evaluated to improve outcomes in this high-risk population.

These findings suggest there is substantial variation in time to adjuvant chemotherapy among stage III colon cancer patients. Reasons for delays may be due to system factors that influence individual providers to make varying decisions on the time of initiation. Future research should identify what these factors may be and how to address them to promote better delivery of care.