Quality Improvement: Preventing Readmission After Ileostomy Formation

Abstract

Readmission after surgery is a problem that is increasingly recognized by surgeons, patients, insurers, and hospitals. It exposes patients to additional risk and increases expense in a variety of predictable ways. Readmission can occur for a number of reasons but in colorectal surgery it falls into a few broad categories: complications related to the operative procedure, functional complications as a result of the procedure, and medical complications unrelated to the procedure but related to hospitalization, anesthesia, or patient comorbidities. Relatively common reasons for readmission following discharge after elective colorectal operation include surgical site infection (wound infection and anastomotic leak or intra-abdominal abscess), high ileostomy output and dehydration, and symptomatic venous thrombosis events. In recent years, a focus on quality metrics has highlighted deficiencies that are possible to target by planned interventions resulting in improvement in patient clinical outcomes as well as health system resource allocation. Surgical site infection and venous thrombosis prevention have been the subject of numerous studies. There are evidence-based guidelines and recommendations focused on creating pathways and specific interventions for these issues already and a chapter on evidence and recommendations could easily be written on each of these problems. Acceptable interventions for ileostomy dehydration are not as well studied and therefore consensus is more difficult.