Advertisement

Techniques in Coloproctology

, Volume 21, Issue 8, pp 641–648 | Cite as

Factors associated with hospital readmission following diverting ileostomy creation

  • W. Li
  • L. StocchiEmail author
  • D. Cherla
  • G. Liu
  • A. Agostinelli
  • C. P. Delaney
  • S. R. Steele
  • E. Gorgun
Original Article

Abstract

Background

The creation of a diverting loop ileostomy is associated with the risk of readmission due to stoma-related complications. We hypothesized that the assessment of our institution-specific readmissions following ileostomy creation would help identifying at-risk groups which should be the focus of future preventative strategies.

Methods

Patients who underwent loop ileostomy formation from 2009 to 2013 were reviewed. We evaluated readmissions within 30 days after discharge following loop ileostomy construction. Possible associations between readmission and demographic, disease-related and treatment-related factors were assessed using univariate and multivariate analyses.

Results

Out of 1267 patients undergoing loop ileostomy construction, 163 patients (12.9%) were readmitted. The main causes of readmissions were organ/space infections (43, 3.4%), small bowel obstruction/ileus (42, 3.3%) and dehydration (38, 3%). Independent factors associated with overall readmission were cardiovascular (OR = 2.0) and renal comorbidity (OR = 2.9), preoperative chemo/radiotherapy (OR = 4.0), laparoscopic approach (OR = 1.7) and longer operative time (OR = 1.2). Cancer diagnosis was associated with reduced readmission rates (OR = 0.2). Independent factors associated with readmission due to dehydration were chemo/radiotherapy (OR = 4.7) and laparoscopic approach (OR = 2.6).

Conclusions

Dehydration associated with diverting ileostomy creation was relevant as an individual cause of readmission, but its overall incidence was relatively rare. Dedicated strategies to prevent dehydration should be directed to patients who received chemoradiotherapy and/or laparoscopic surgery.

Keywords

Readmission Diverting ileostomy Educational ileostomy pathways 

Notes

Author contributions

All authors made substantial contributions to concept and design, acquisition of data, analysis and interpretation of data, drafting the article and revising the article critically. All authors approve of the final version to be published.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable ethical standards were adhered to in the performance of this study and creation of the submitted manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Wexner SD, Taranow DA, Johansen OB et al (1993) Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum 36:349–354CrossRefPubMedGoogle Scholar
  2. 2.
    Thalheimer A, Bueter M, Kortuem M, Thiede A, Meyer D (2006) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum 49:1011–1017CrossRefPubMedGoogle Scholar
  3. 3.
    Weise WJ, Serrano FA, Fought J, Gennari FJ (2008) Acute electrolyte and acid-base disorders in patients with ileostomies: a case series. Am J Kidney Dis 52:494–500CrossRefPubMedGoogle Scholar
  4. 4.
    Messaris E, Sehgal R, Deiling S et al (2012) Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum 55:175–180CrossRefPubMedGoogle Scholar
  5. 5.
    Wick EC, Shore AD, Hirose K et al (2011) Readmission rates and cost following colorectal surgery. Dis Colon Rectum 54:1475–1479CrossRefPubMedGoogle Scholar
  6. 6.
    Tyler JA, Fox JP, Dharmarajan S et al (2014) Acute health care resource utilization for ileostomy patients is higher than expected. Dis Colon Rectum 57:1412–1420CrossRefPubMedGoogle Scholar
  7. 7.
    Figueiredo MN, Mege D, Maggiori L, Ferron M, Panis Y (2015) When is the best time for temporary stoma closure in laparoscopic sphincter-saving surgery for rectal cancer? A study of 259 consecutive patients. Tech Coloproctol 19:469–474. doi: 10.1007/s10151-015-1328-z CrossRefPubMedGoogle Scholar
  8. 8.
    Beck-Kaltenbach N, Voigt K, Rumstadt B (2011) Renal impairment caused by temporary loop ileostomy. Int J Colorectal Dis 26:623–626CrossRefPubMedGoogle Scholar
  9. 9.
    Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR (2013) Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum 56:974–979CrossRefPubMedGoogle Scholar
  10. 10.
    Costantino ME, Frey B, Hall B, Painter P (2013) The influence of a postdischarge intervention on reducing hospital readmissions in a Medicare population. Popul Health Manag 16:310–316CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Joynt KE, Jha AK (2013) A path forward on Medicare readmissions. N Engl J Med 368:1175–1177CrossRefPubMedGoogle Scholar
  12. 12.
    Zigmond J (2012) Avoiding the penalty box. New rules on readmissions push hospitals, post-acute providers into closer collaboration. Mod Healthc 42:38–39PubMedGoogle Scholar
  13. 13.
    Aspenson M, Hazary S (2012) The clock is ticking on readmission penalties. Healthc Financ Manag 66:58–63Google Scholar
  14. 14.
    Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82:703–710CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Philbin EF, Dec GW, Jenkins PL, DiSalvo TG (2001) Socioeconomic status as an independent risk factor for hospital readmission for heart failure. Am J Cardiol 87:1367–1371CrossRefPubMedGoogle Scholar
  16. 16.
    Shepperd S, Lannin NA, Clemson LM, McCluskey A, Cameron ID, Barras SL (2013) Discharge planning from hospital to home. Cochrane Database Syst Rev 1:CD000313Google Scholar
  17. 17.
    McPhee JT, Nguyen LL, Ho KJ, Ozaki CK, Conte MS, Belkin M (2013) Risk prediction of 30-day readmission after infrainguinal bypass for critical limb ischemia. J Vasc Surg 57:1481–1488CrossRefPubMedGoogle Scholar
  18. 18.
    (2013) Readmission reduction has begun and the penalties will escalate. Hosp Case Manag 21:45–7Google Scholar
  19. 19.
    Burke RE, Coleman EA (2013) Interventions to decrease hospital readmissions: keys for cost-effectiveness. JAMA Intern Med 173:695–698CrossRefPubMedGoogle Scholar
  20. 20.
    Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859CrossRefPubMedGoogle Scholar
  21. 21.
    Chalikias G, Drosos I, Tziakas DN (2016) Contrast-induced acute kidney injury: an update. Cardiovasc Drugs Ther 30:215–228CrossRefPubMedGoogle Scholar
  22. 22.
    Fazio VW, Kiran RP, Remzi FH et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685CrossRefPubMedGoogle Scholar
  23. 23.
    Erkek AB, Remzi FH, Hammel JP, Akyuz M, Fazio VW (2008) Effect of small bowel obstruction on functional outcome and quality of life in patients with ileal pouch-anal anastomosis: 10-year follow-up study. Gastroenterology 23:119–125Google Scholar
  24. 24.
    Fazio VW, Cohen Z, Fleshman JW et al (2005) Reduction in adhesive small-bowel obstruction by Seprafilm Adhesion Barrier after intestinal resection. Dis Colon Rectum 49:1–11CrossRefGoogle Scholar
  25. 25.
    Guinier D, Mantion GA, Alves A et al (2007) Association Francaise de Chirurgie. Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study. Dis Colon Rectum 50:1316–1323CrossRefPubMedGoogle Scholar
  26. 26.
    Schneider EB, Hyder O, Brooke BS et al (2012) Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. J Am Coll Surg 214:390–398 (discussion 398–9) CrossRefPubMedGoogle Scholar
  27. 27.
    Hayden DM, Pinzon MC, Francescatti AB et al (2013) Hospital readmission for fluid and electrolyte abnormalities following ileostomy construction: preventable or unpredictable? J Gastrointest Surg 17:298–303CrossRefPubMedGoogle Scholar
  28. 28.
    Nagle D, Pare T, Keenan E, Marcet K, Tizio S, Poylin V (2012) Ileostomy pathway virtually eliminates readmissions for dehydration in new ostomates. Dis Colon Rectum 55:1266–1272CrossRefPubMedGoogle Scholar
  29. 29.
    Younis J, Salerno G, Fanto D, Hadjipavlou M, Chellar D, Trickett JP (2012) Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme. Int J Colorectal Dis 27:43–47CrossRefPubMedGoogle Scholar
  30. 30.
    Mary RK, Sarah WG, Ann CL et al (2016) Education program for prevention of ileostomy complications (EPPIC): a randomized trial. J Am Coll Surg 223(Supplement 2):e7–e8Google Scholar
  31. 31.
    Ozturk E, Kiran RP, Remzi F, Fazio VW (2009) Early readmission after ileoanal pouch surgery. Dis Colon Rectum 52:1848–1853CrossRefPubMedGoogle Scholar
  32. 32.
    Turina M, Remzi FH, Dietz DW et al (2013) Quantification of risk for early unplanned readmission after rectal resection: a single-center study. J Am Coll Surg 217:200–208CrossRefPubMedGoogle Scholar
  33. 33.
    ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159CrossRefGoogle Scholar
  34. 34.
    Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29:3443–3453CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Chun LJ, Haigh PI, Tam MS, Abbas MA (2012) Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum 55:167–174CrossRefPubMedGoogle Scholar
  36. 36.
    Noori A, Shokoohi M, Baneshi MR, Naderi N, Bakhshandeh H, Haghdoost AA (2014) Impact of socio-economic status on the hospital readmission of congestive heart failure patients: a prospective cohort study. Int J Health Policy Manag 3:251–257CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Quillin RC 3rd, Wilson GC, Wima K et al (2014) Neighborhood level effects of socioeconomic status on liver transplant selection and recipient survival. Clin Gastroenterol Hepatol 12:1934–1941CrossRefPubMedGoogle Scholar
  38. 38.
    Arbaje AI, Wolff JL, Yu Q, Powe NR, Anderson GF, Boult C (2008) Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. Gerontologist 48:495–504CrossRefPubMedGoogle Scholar
  39. 39.
    Blum AB, Egorova NN, Sosunov EA et al (2014) Impact of socioeconomic status measures on hospital profiling in New York City. Circ Cardiovasc Qual Outcomes 7:391–397CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • W. Li
    • 1
    • 2
  • L. Stocchi
    • 1
    Email author
  • D. Cherla
    • 1
  • G. Liu
    • 1
  • A. Agostinelli
    • 1
  • C. P. Delaney
    • 1
  • S. R. Steele
    • 1
  • E. Gorgun
    • 1
  1. 1.Department of Colorectal Surgery, Digestive Disease and Surgery InstituteCleveland ClinicClevelandUSA
  2. 2.Department of Gastrointestinal Surgery, Guangzhou First People’s HospitalGuangzhou Medical UniversityGuangzhouChina

Personalised recommendations