Loop Ileostomy Closure as an Overnight Procedure: Institutional Comparison With the National Surgical Quality Improvement Project Data Set

Berger, Nicholas G.; Chou, Raymond; Toy, Elliot S.; Ludwig, Kirk; Ridolfi, Timothy J.; Peterson, Carrie Y.

doi:10.1097/dcr.0000000000000793

Cited by 17 publications

(7 citation statements)

References 28 publications

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“…Loop ileostomy closure (LIC) as a seemingly simple procedure was repeatedly associated with considerable morbidity, with overall complication rates of up to 45% and reoperation rates of up to 7% [1][2][3]. More recently, several authors advocated LIC as a same-day procedure in selected patients [4,5]. However, only a few patients were eligible for an ambulant hospital management in a recent analysis [6].…”

Section: Introductionmentioning

confidence: 99%

Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

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Pache

Butti

et al. 2019

Langenbecks Arch Surg

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Purpose The present study aimed to analyze the impact of perioperative fluid management on postoperative ileus (POI) after loop ileostomy closure. Methods Consecutive loop ileostomy closures over a 6-year period (May 2011-May 2017) were included. Main outcomes were POI, defined as time to first stool beyond POD 3, and postoperative complications of any grade. Critical fluid managementrelated thresholds including postoperative weight gain were identified through receiver operator characteristics (ROC) analysis and tested in a multivariable analysis. Results Of 238 included patients, 33 (14%) presented with POI; overall complications occurred in 91 patients (38%). 1.7 L IV fluids at postoperative day (POD) 0 was determined a critical threshold for POI (area under ROC curve (AUROC), 0.64), yielding a negative predictive value (NPV) of 93%. Further, a critical cutoff for a postoperative weight gain of 1.2 kg at POD 2 was identified (AUROC, 0.65; NPV, 95%). Multivariable analysis confirmed POD 0 fluids of > 1.7 L (OR, 4.7; 95% CI, 1.4-15.3; p = 0.01) and POD 2 weight gain of > 1.2 kg (OR, 3.1; 95% CI, 1-9.4; p = 0.046) as independent predictors for POI. Conclusions Perioperative fluid administration of > 1.7 L and POD 2 weight gain of > 1.2 kg represent critical thresholds for POI after loop ileostomy closure.

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Section: Introductionmentioning

confidence: 99%

Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

Grass

Pache

Butti

et al. 2019

Langenbecks Arch Surg

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“…The study concluded that the next-day discharge with protocol diet advancement and telephone follow-up is acceptable after loop ileostomy closure. Patients can benefit from decreased length of stay without an increase in readmission or complications [10].…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Enhanced Recovery after Surgery (ERAS) Protocol in Patients Undergoing Stoma Closure

et al. 2020

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Enhanced Recovery after Surgery (ERAS) protocol is a multimodal approach which includes variety of pre-, intra-, and postoperative components to minimize surgical trauma, reduce complications, and decrease hospital length of stay, while expediting accelerated recovery following elective procedures. This study aimed to compare the postoperative outcome using the conventional management versus ERAS protocol in patients undergoing stoma (ileostomy and colostomy) closure. A prospective, comparative, longitudinal study was conducted using census technique in 30 patients admitted to surgery department, between January 2018 and March 2019 for ileostomy or colostomy closure. The postoperative length of hospital stay, readmission, morbidity, and mortality were compared between two groups of participants undergoing stoma closure either by ERAS (group A, n = 15) or by conventional care (group B, n = 15) protocol. Chi-square test and Student t test were used for analysis. The mean postoperative length of hospital stay was shorter in ERAS group compared with conventional care group (1.5 vs. 6.5 days, p < 0.001). However, no statistically significant differences were reported in terms of readmission and morbidity between the two groups. One major morbidity (anastomotic leak) in conventional group was reported. There was no 30-day mortality in either group. In comparison with the conventional care group, the application of ERAS protocol in the stoma closure resulted in decreased postoperative length of hospital stay. No differences were observed for readmission, re-exploration, and other postoperative morbidities between the two groups.

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“…Concerning the postoperative care, this should not be a reason to exclude day case ileostomy closure of current practice. If patients are well instructed, and factors for dismissing patients after ambulant surgery are fulfilled, studies have shown ambulant therapy can be applied [23,24]. However, the hospital needs to have the resources to quickly and easily re-hospitalize these patients.…”

Section: Discussionmentioning

confidence: 99%

Application of an enhanced recovery pathway for ileostomy closure: a case–control trial with surprising results

et al. 2018

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Loop Ileostomy Closure as an Overnight Procedure: Institutional Comparison With the National Surgical Quality Improvement Project Data Set

Cited by 17 publications

References 28 publications

Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

Safety and Feasibility of Enhanced Recovery after Surgery (ERAS) Protocol in Patients Undergoing Stoma Closure

Application of an enhanced recovery pathway for ileostomy closure: a case–control trial with surprising results

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