Clinical Practice Guidelines for Ostomy Surgery

Hendren, Samantha; Hammond, Kerry L.; Glasgow, Sean C.; Perry, W. Brian; Buie, W. Donald; Steele, Scott R.; Rafferty, Janice

doi:10.1097/dcr.0000000000000347

Cited by 144 publications

(179 citation statements)

References 132 publications

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“…Although many post-operative management practices were shared between surgeons, neither hospital had instituted formal ERAS programs at the time of study, which have been recommended by the ASCRS for new ileostomy patients 20 . Nagle et al 9 have demonstrated that early patient autonomy in ostomy care can potentially reduce readmissions, which was not described at time of our study.…”

Section: Discussionmentioning

confidence: 99%

Readmission After Ileostomy Creation

et al. 2017

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Objective To evaluate causes and predictors of readmission after new ileostomy creation. Summary Background New ileostomates have been reported to have higher readmission rates compared to other surgical patients, but data on predictors are limited. Methods 1114 records at two associated hospitals were reviewed to identify adults undergoing their first ileostomy. Primary outcome was readmission within 60 days of surgery. Multiple logistic regression was used to identify independent predictors; receiver-operator characteristics (AUC) were used to evaluate age-stratified models in secondary analysis. Results 407 patients underwent new ileostomy. 58% had cancer, 31% IBD; 49% underwent LAR, 27% colectomy, 14% proctocolectomy. Median length-of-stay was 8 days. 39% returned to hospital; 28% were readmitted (n=113) at median of 12 days post-discharge. The most common causes of readmission were dehydration (42%), intra-peritoneal infections (33%), and extra-peritoneal infections (29%). Dehydration was associated with later, longer, and repeated readmission. Independent significant predictors of readmission were Clavien-Dindo complication grade 3–4 (OR 6.7), Charlson comorbidity index (OR 1.4 per point), and loop stoma (OR 2.2); longer length-of-stay (OR 0.5) and age 65 or older (OR 0.4) were protective. Cohort stratification above or below age 65 revealed that older patient readmissions were more predictable (AUC 0.84) with more preventable causes; younger patient readmissions were difficult to predict or prevent (AUC 0.65). Conclusions Readmissions are most commonly caused by dehydration, and are predicted by serious complications, comorbidity burden, loop stoma, shorter length-of-stay, and age. Readmissions in older patients are easier to predict, representing an important target for improvement.

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Section: Discussionmentioning

confidence: 99%

Readmission After Ileostomy Creation

et al. 2017

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“…O auxílio terapêutico das estomias, principalmente das colostomias aos distúrbios colorretais, são bastante consistentes, porém tal procedimento pode acarretar múltiplas complicações. Estas apresentam elevados índices de morbimortalidade, o que contribui para a diminuição da qualidade de vida dos pacientes estomizados (6,10) . As complicações, que podem ser classificadas em recentes ou tardias, geram hospitalizações mais longas e maiores taxas de readmissão, cursando com elevados custos hospitalares (11) .…”

Section: Introductionunclassified

Cuidado e saúde em pacientes estomizados

Oliveira

Silva

et al. 2018

RBPS

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Este artigo está publicado em acesso aberto (Open Access) sob a licença Creative Commons, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho seja corretamente citado. CUIDADO E SAÚDE EM PACIENTES ESTOMIZADOS Care and health of ostomy patients Cuidado y salud de pacientes estomizados Isabella Valadares de OliveiraPontifícia Universidade Católica de Goiás -PUC Goiás -Goiânia (GO) -Brasil Mariana Cabral SilvaPontifícia Universidade Católica de Goiás -PUC Goiás -Goiânia (GO) -Brasil Eduardo Lenza SilvaPontifícia Universidade Católica de Goiás -PUC Goiás -Goiânia (GO) -Brasil Victor Fernandes de FreitasPontifícia Universidade Católica de Goiás -PUC Goiás -Goiânia (GO) -Brasil Fernando Rezek RodriguesUniversidade Federal de Goiás -UFG -Goiânia (GO) -Brasil Luciana Morelli CaldeiraPontifícia Universidade Católica de Goiás -PUC Goiás -Goiânia (GO) -Brasil Santa Casa de Misericórdia de Goiânia -Goiânia (GO) -Brasil RESUMO Objetivo: Descrever os aspectos epidemiológicos, as complicações e as hospitalizações relacionadas à estomia. Métodos: Trata-se de um estudo transversal, descritivo e quantitativo das variáveis: sexo, idade, faixa etária, raça/cor, tempo de estomia, tipo de estomia, etiologia, complicações e internações hospitalares associadas à colostomia de 123 pacientes atendidos no ambulatório de enfermagem para pacientes estomizados de um hospital escola em Goiânia, Goiás, Brasil. Após a disposição dos dados em tabelas, utilizou-se o software Epi Info 7 para a descrição dos resultados, a análise de prevalências e a associação de variáveis. Resultados: 51,2% (n=63) dos pacientes eram do sexo masculino e houve predominância do tipo de colostomia terminal (n=68;57,6%), enquanto 24,5% (n=29) era do tipo em alça e 17% (n=20) do tipo dupla boca. Quanto à etiologia da estomia, 40,5% (n=49) ocorreu por neoplasia, 17,3% (n=21) por doença inflamatória intestinal e 9% (n=11) por trauma. O desenvolvimento de complicações esteve presente em 38 (30,89%) pacientes, sendo a dermatite periestomal a principal delas, e 9 (7%) pacientes necessitaram de internação hospitalar relacionada à estomia. Conclusão: Observa-se que os pacientes investigados apresentam predominância do sexo masculino, média de idade de 61,5 anos, raça/cor parda, de colostomia terminal e etiologia neoplásica, sendo a maioria dos pacientes portadores de colostomia há cerca de 5 anos. Descritores

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“…Although perioperative stoma education is considered a standard of care for new ileostomy patients 7 , and a key factor in preventing readmissions, there are few studies to inform the optimal timing, content, and effectiveness of ileostomy care pathways in the setting of accelerated postoperative discharge. As a part of enhanced recovery programs, peri-operative stoma teaching reduces postoperative length of stay and complications, but has not been associated with an overall reduction in readmissions 8, 9 .…”

Section: Introductionmentioning

confidence: 99%

Patient autonomy–centered self-care checklist reduces hospital readmissions after ileostomy creation

Hardiman

Reames

McLeod

et al. 2016

Surgery

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Background Patients who undergo colorectal surgery with new ileostomies incur high rates of readmission. Ostomates face a steep learning curve to master the skills and knowledge needed for success at home. We designed and implemented a patient-centered checklist promoting independence and validating self-care knowledge and care skills, and evaluated its effect on readmissions after ileostomy creation. Methods On a single inpatient unit, new ileostomy patients were taught and evaluated using a novel postoperative self-care checklist, while perioperative care for ostomates remained unchanged elsewhere in the institution. In a retrospective cohort including all consecutive ileostomy patients from two years before (Period 1) and one year after (Period 2) checklist implementation, we identified univariable predictors of readmission within 30 days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units. Results Of the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly higher All Patient Refined-Diagnosis Related Group weights (3.6 vs. 3.3, p=0.006), longer initial length of stay (13.3 vs. 11.3 days, p=0.006) and were more likely to be emergency admissions (49% vs. 38%, p=0.04). The readmission rate on the intervention unit decreased from 28% in Period 1 to 20% in Period 2. The logistic regression-based difference-in-differences approach revealed that implementation of the checklist was an independent negative predictor of readmission (p=0.04). Conclusion Implementation of a patient-centered, self-care oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation in colorectal surgery.

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Clinical Practice Guidelines for Ostomy Surgery

Cited by 144 publications

References 132 publications

Readmission After Ileostomy Creation

Readmission After Ileostomy Creation

Cuidado e saúde em pacientes estomizados

Patient autonomy–centered self-care checklist reduces hospital readmissions after ileostomy creation

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