Skip to main content

Advertisement

SpringerLink
Log in

Identifying causes for high readmission rates after stoma reversal

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Unplanned readmissions after colorectal surgery impact patient and financial outcomes. Our goal was to identify factors related to readmission in ostomy reversal patients.

Methods

Review of a prospective department database was performed from 2006 to 2012 to identify patients who underwent an ostomy reversal. Patients were stratified into nonreadmitted and readmitted within 30 days of ostomy reversal. The main outcome measures were predictors of readmission and characteristics of patients readmitted and not readmitted.

Results

A total of 351 ostomy reversals (86 % ileostomy and 14 % colostomy) were analyzed; 44 patients were readmitted (12.5 %). Readmitted and nonreadmitted patients were similar in age, body mass index, gender, comorbidities, indications for the index operation, and time to ostomy reversal. Readmitted patients had longer operative times (p = 0.002) and length of stay (p = 0.001), more intraoperative blood loss (p = 0.003), intraoperative complications (p = 0.005), ICU requirements (p < 0.0001), need for temporary nursing at discharge (p < 0.001), and higher total hospital costs than nonreadmitted patients (p = 0.0162). Longer operative time [odds ratio (OR) 1.006, 95 % confidence interval (CI) 1.001–1.012], intraoperative complications (OR 7.334, 95 % CI 1.23–43.761), ICU stay (OR 1.291, 95 % CI 1.18–1.893), delayed discharge (OR 1.085, 95 % CI 1.003–1.173), and discharge to skilled nursing facility (OR 6.936, 95 % CI 1.531–31.332) were independent predictors of readmission. Ostomy type had no independent effect on readmission.

Conclusions

Differences in perioperative and outcomes variables exist between readmitted and nonreadmitted patients after ostomy reversal. Longer operative times, intraoperative complications, intensive care unit care, longer length of stay, and skilled nursing at discharge were independently predictive of readmission. These findings can be used to identify high-risk patients prospectively, potentially improving clinical outcomes and healthcare utilization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schneider EB, Hyder O, Brooke BS, Efron J, Cameron JL, Edil BH, Schulick RD, Choti MA, Wolfgang CL, Pawlik TM (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(4):390–398 discussion 398–399

    Article  PubMed  Google Scholar 

  2. Wick EC, Shore AD, Hirose K, Ibrahim AM, Gearhart SL, Efron J, Weiner JP, Makary MA (2011) Readmission rates and cost following colorectal surgery. Dis Colon Rectum 54(12):1475–1479

    Article  PubMed  Google Scholar 

  3. Centers for Medicare and Medicaid Readmissions Reduction Program (2012) http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html/. Accessed 2 Aug 2013

  4. Azimuddin K, Rosen L, Reed JF, Stasik JJ, Riether RD, Khubchandani IT (2001) Readmissions after colorectal surgery cannot be predicted. Dis Colon Rectum 44(7):942–946

    Article  CAS  PubMed  Google Scholar 

  5. Guinier D, Mantion GA, Alves A, Kwiatkowski F, Slim K, Panis Y (2007) Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study. Dis Colon Rectum 50(9):1316–1323

    Article  CAS  PubMed  Google Scholar 

  6. Faiz O, Haji A, Burns E, Bottle A, Kennedy R, Aylin P (2011) Hospital stay amongst patients undergoing major elective colorectal surgery: predicting prolonged stay and readmissions in NHS hospitals. Colorectal Dis 13(7):816–822

    Article  CAS  PubMed  Google Scholar 

  7. Kelly M, Sharp L, Dwane F, Kelleher T, Comber H (2012) Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions. BMC Health Serv Res 12:77

    Article  PubMed  PubMed Central  Google Scholar 

  8. Keller DS, Swendseid B, Khan S, Delaney CP (2013) Readmissions after ileostomy closure: cause to revisit a standardized enhanced recovery pathway? Am J Surg (in press)

  9. Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238(1):67–72

    PubMed  PubMed Central  Google Scholar 

  10. Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149(6):830–840

    Article  PubMed  Google Scholar 

  11. Delaney CP (2008) Outcome of discharge within 24–72 h after laparoscopic colorectal surgery. Dis Colon Rectum 51(2):181–185

    Article  PubMed  Google Scholar 

  12. Delaney CP, Brady K, Woconish D, Parmar SP, Champagne BJ (2012) Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways. Am J Surg 203(3):353–355 discussion 355–356

    Article  PubMed  Google Scholar 

  13. Hayden DM, Pinzon MC, Francescatti AB, Edquist SC, Malczewski MR, Jolley JM, Brand MI, Saclarides TJ (2013) Hospital readmission for fluid and electrolyte abnormalities following ileostomy construction: preventable or unpredictable? J Gastrointest Surg 17(2):298–303

    Article  PubMed  Google Scholar 

  14. Messaris E, Sehgal R, Deiling S, Koltun WA, Stewart D, McKenna K, Poritz LS (2012) Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum 55(2):175–180

    Article  PubMed  Google Scholar 

  15. Beck-Kaltenbach N, Voigt K, Rumstadt B (2011) Renal impairment caused by temporary loop ileostomy. Int J Colorectal Dis 26(5):623–626

    Article  PubMed  Google Scholar 

  16. Bax TW, McNevin MS (2007) The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis. Am J Surg 193(5):585–587 discussion 587–588

    Article  PubMed  Google Scholar 

  17. Rullier E, Le Toux N, Laurent C, Garrelon JL, Parneix M, Saric J (2001) Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 25(3):274–277 discussion 277–278

    Article  CAS  PubMed  Google Scholar 

  18. Wexner SD, Taranow DA, Johansen OB, Itzkowitz F, Daniel N, Nogueras JJ, Jagelman DG (1993) Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum 36(4):349–354

    Article  CAS  PubMed  Google Scholar 

  19. Williams LA, Sagar PM, Finan PJ, Burke D (2008) The outcome of loop ileostomy closure: a prospective study. Colorectal Dis 10(5):460–464

    Article  CAS  PubMed  Google Scholar 

  20. Kalady MF, Fields RC, Klein S, Nielsen KC, Mantyh CR, Ludwig KA (2003) Loop ileostomy closure at an ambulatory surgery facility: a safe and cost-effective alternative to routine hospitalization. Dis Colon Rectum 46(4):486–490

    Article  PubMed  Google Scholar 

  21. Ihedioha U, Muhtaseb S, Kalmar K, Donnelly L, Muir V, Macdonald A (2010) Closure of loop ileostomies: is early discharge safe and achievable? Scott Med J 55(1):27–29

    Article  CAS  PubMed  Google Scholar 

  22. Joh YG, Lindsetmo RO, Stulberg J, Obias V, Champagne B, Delaney CP (2008) Standardized postoperative pathway: accelerating recovery after ileostomy closure. Dis Colon Rectum 51(12):1786–1789

    Article  PubMed  Google Scholar 

  23. Wong KS, Remzi FH, Gorgun E, Arrigain S, Church JM, Preen M, Fazio VW (2005) Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon Rectum 48(2):243–250

    Article  PubMed  Google Scholar 

  24. Baraza W, Wild J, Barber W, Brown S (2010) Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long? Ann R Coll Surg Engl 92(1):51–55

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Mansfield SD, Jensen C, Phair AS, Kelly OT, Kelly SB (2008) Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients. World J Surg 32(9):2101–2106

    Article  CAS  PubMed  Google Scholar 

  26. Lin FL, Boutros M, Da Silva GM, Weiss EG, Lu XR, Wexner SD (2013) Hartmann reversal: obesity adversely impacts outcome. Dis Colon Rectum 56(1):83–90

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Keller, Khorgami, Khan, Delaney, and Mr. Swendseid have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106-5047, USA

    Deborah S. Keller, Zhamak Khorgami, Sadaf Khan & Conor P. Delaney

  2. Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran

    Zhamak Khorgami

  3. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Brian Swendseid

Authors
  1. Deborah S. Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhamak Khorgami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian Swendseid
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sadaf Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Conor P. Delaney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah S. Keller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keller, D.S., Khorgami, Z., Swendseid, B. et al. Identifying causes for high readmission rates after stoma reversal. Surg Endosc 28, 1263–1268 (2014). https://doi.org/10.1007/s00464-013-3320-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-3320-x

Keywords

Search

Navigation