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Short-stay compared to long-stay admissions for loop ileostomy reversals: a systematic review and meta-analysis

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Abstract

Purpose

Short-stay admissions, with lengths of stay less than 24 h, are used for various surgeries without increasing adverse events. However, it is unclear if short-stay admissions would be safe for loop ileostomy reversals. This review aimed to compare outcomes between short (≤24 hours) and long (>24 hours) admissions for adults undergoing loop ileostomy reversals.

Methods

Medline, Embase, CINAHL, Web of Science, and the Cochrane Library were systematically searched for studies comparing short- to long-stay admissions in adults undergoing loop ileostomy reversals. Meta-analyses were conducted for mortality, reoperation, readmission, and non-reoperative complications. Quality of evidence was assessed with grading of recommendations, assessment, development, and evaluations (GRADE) guidelines.

Results

Four observational studies enrolling 24,628 patients were included. Moderate certainty evidence suggests there is no difference in readmissions between short- and long-stay admissions (relative risk (RR) 0.98, 95% CI 0.75 to 1.28, p 0.86). Low certainty evidence demonstrates that short stays may reduce non-reoperative complications (RR 0.44, 95% CI 0.31 to 0.62, p < 0.01). Very low certainty evidence demonstrates that there is no difference in reoperations between short and long stays (RR 1.14, 95% CI 0.26 to 5.04, p 0.87).

Conclusions

Moderate certainty evidence demonstrates that there is no difference in readmission rates between short- and long-stay admissions for loop ileostomy reversals. Less robust evidence suggests equivalence in reoperations and a decrease in non-reoperative complications. Future prospective trials are required to evaluate the feasibility and efficacy of short-stay admissions.

Trial Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=307381 Prospero (CRD42022307381), January 30, 2022.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada

    Victoria Archer, Zacharie Cloutier, Tyler McKechnie & Cagla Eskicioglu

  2. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Annie Berg

  3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Victoria Archer & Wojtek Wiercioch

Authors
  1. Victoria Archer
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  2. Zacharie Cloutier
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  3. Annie Berg
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  4. Tyler McKechnie
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  5. Wojtek Wiercioch
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  6. Cagla Eskicioglu
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Contributions

All authors contributed to the study’s conception and design. Victoria Archer designed the literature search. Victoria Archer, Zacharie Cloutier, and Annie Berg contributed to data extraction and analysis. Victoria Archer wrote the first draft of the manuscript. Tyler McKechnie, Wojtek Wiercioch, and Cagla Eskicioglu performed revisions and aided in the preparation of the final manuscript.

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Correspondence to Victoria Archer.

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Archer, V., Cloutier, Z., Berg, A. et al. Short-stay compared to long-stay admissions for loop ileostomy reversals: a systematic review and meta-analysis. Int J Colorectal Dis 37, 2113–2124 (2022). https://doi.org/10.1007/s00384-022-04256-x

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