Impact of a nutrition consultation on the rate of high output stoma-related readmission: an ambispective cohort study

Abstract

The aims of this study were to assess the impact of a follow-up nutrition consultation for ostomy patients on the rate of high output stoma (HOS)-related readmissions, as well as on the detection of poor nutritional status and their management, and to determine the associated economic impact. A single-centre ambispective cohort study was conducted in which all adult patients undergoing intestinal resection and stoma creation were recruited. Two nutrition consultations were established for early follow-up after hospital discharge and patients were prospectively included. Additionally, a retrospective search was carried out to include a control group. In both groups, a 12-month follow-up was conducted to record readmissions associated with high output stoma. A multivariate logistic regression was performed. Statistical significance level was established at p < 0.05. 170 patients were recruited, 85 patients in each cohort. Demographic data and clinical characteristics were recorded. A significant difference was observed in HOS-related readmissions, with readmission rates of 28.6% vs 10.3% in the retrospective and prospective cohort, respectively. At the first follow-up consultation, 50.5% of patients presented some degree of protein-calorie malnutrition. A statistically significant improvement in nutritional status was observed in the second evaluation. The intervention carried out resulted in a total saving of €24,175. Early follow-up of patients after discharge resulted in a significant reduction in the rate of HOS-related readmissions and allowed to identify a high percentage of patients with malnutrition. The cost analysis showed the process to be a cost-effective improvement.

Nutritional Issues Faced by Patients with Intestinal Stoma: A Narrative Review

“…Other researchers have reached similar conclusions, citing HOS as the most common cause of readmission [ 37 , 38 , 39 ]. Many researchers reported significantly lower rates of patients returning to the hospital after implementation of a follow-up nutritional consultation compared to the non-intervention group in a retrospective study compared to other researchers [ 13 , 43 , 44 , 45 ].…”

“…Santamaria et al [ 13 ] used the SGA for the assessment of nutrition in a group of patients with ileostomy with High Output Stoma (HOS), which is a well-known and standardized tool. In addition, patients with colon cancer who underwent a scheduled ileostomy surgery, were diagnosed before and after with the MNA [ 14 ].…”

“…The last two questionnaires are based on similar questions, and are slightly longer, however, still fit on one page. This allows them to be carried out efficiently and repeated regularly during the patients’ stay in the hospital [ 13 , 14 , 15 ]. If a patient is qualified for a nutritional treatment, the first step is to perform an in-depth evaluation of the nutritional status of that patient.…”

“…Recently, some interesting studies on educational support and nutritional consultation for patients with an intestinal stoma have been published [ 13 , 42 , 43 ].…”

“…In a Spanish cohort conducted by Santamaria et al [ 13 ] involving 170 patients (85 each in the study and control groups), patients underwent two nutritional consultations after hospital discharge. They found that such consultations significantly reduced the rate of hospital readmissions associated with high-secreting stoma and dehydration, which also resulted in significant savings for the hospital [ 13 ]. Other researchers have reached similar conclusions, citing HOS as the most common cause of readmission [ 37 , 38 , 39 ].…”