Readmissions With Dehydration After Ileostomy Creation: Rethinking Risk Factors

Abstract

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.

Validation of a Novel Connected “Smart” Stoma Bag to Monitor Output in Ostomates

“…is higher than expected in stoma patients [25]. Recent studies have advocated better monitoring of ostomates and tailored interventions to reduce complications and improve self-monitoring [5,26].…”

“…Complication rates for stoma patients exceed 55% [4] and in a review of all US healthcare data, the all cause 30-day readmission rate for ileostomy patients matched kidney transplant at 29.1% [5]. Commonly reported complications include acute kidney injury, skin complications and a reduced quality of life [6].…”

“…Commonly reported complications include acute kidney injury, skin complications and a reduced quality of life [6]. Dehydration is the most common cause for readmission present in approximately 40% and the subsequent impact on the kidneys can lead to renal failure which is consistently reported in 17-26% of patients [5,7]. Dehydration and acute kidney injury may be precipitated by high output stoma (HOS), defined as ostomy output >1500 ml/d for two or more consecutive days.…”

Early versus standard closure of temporary ileostomy in patients with rectal cancer: A randomized controlled trial

“…Some of these complications are severe since 8% of patients require reoperation and 4% suffer such serious complications as ileal anastomotic leakage . While having ileostomy some patients suffer stoma‐related complications—dehydration, peristomal skin irritation, parastomal hernia, stoma caused obstruction, high output stoma—causing up to 30% of readmissions . However, still, most of the surgeons prefer ileostomy over colostomy because of easier closure and a lower rate of stoma‐related complications …”

Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients

“…[2,3] In addition, given the possible complications associated with the presence of ileostomy, such as electrolyte disturbances, renal dysfunction, and the risk of surgical complications associated with the ileostomy itself and ileostomy closure procedures, it is necessary to de ne the group of patients who actually bene t from elective diversion. [4,5,6] The rate of nonclosure of the stoma is di cult to compare due to different criteria adopted by authors, including different latest expected time to closure which ranges from 9 to 36 months. In different centres patients are quali ed for the closure of LI before, at the time of or after adjuvant treatment.…”