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Standardized Postoperative Pathway: Accelerating Recovery after Ileostomy Closure

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

In this study we evaluated the outcome of a standardized enhanced recovery program in patients undergoing ileostomy closure.

Methods

Forty-two patients underwent ileostomy closure by a single surgeon and were managed by a standardized postoperative care pathway. On the first postoperative day, patients received oral analgesia and a soft diet. Discharge was based on standard criteria previously published for laparoscopic colectomy patients. Results were recorded prospectively in an Institutional Review Board-approved database, including demographics, operative time, blood loss, complications, length of stay, and readmission data.

Results

The median operative time and blood loss were 60 minutes and 17.5 mL, respectively, and median hospital stay was 2 days. Twenty-nine patients (69 percent) were discharged by postoperative Day 2. The complication rate was 23.8 percent; complications included prolonged postoperative ileus (n = 3), early postoperative small-bowel obstruction (n = 1), mortality not related to ileostomy closure (n = 1), minor bleeding (n = 1), wound infection (n = 1), incisional hernia (n = 1), diarrhea (n = 1), dehydration (n = 1). The 30-day readmission rate was 9.5 percent (n = 4). Two patients had reoperation within 30 days for small-bowel obstruction and a wound infection.

Conclusions

Ileostomy closure patients managed with postoperative care pathways can have a short hospital stay with acceptable morbidity and readmission rates.

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Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Yong-Geul Joh M.D., Rolv-Ole Lindsetmo M.D., Ph.D., Jonah Stulberg M.P.H., Vincent Obias M.D., Brad Champagne M.D. & Conor P. Delaney M.D., Ph.D.

Authors
  1. Yong-Geul Joh M.D.
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  2. Rolv-Ole Lindsetmo M.D., Ph.D.
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  3. Jonah Stulberg M.P.H.
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  4. Vincent Obias M.D.
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  5. Brad Champagne M.D.
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  6. Conor P. Delaney M.D., Ph.D.
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Corresponding author

Correspondence to Conor P. Delaney M.D., Ph.D..

Additional information

Dr. Conor P. Delaney receives research funding, research honorarium, and is a consultant and speaker for Adolor and Ethicon Endosurgery; receives research funding, research honorarium and is a speaker for Covidien; receives research funding, research honorarium and is a consultant for WL Gore; receives honorarium and is a consultant for Global Medical Group and Wyeth.

Dr. Brad Champagne is a paid speaker for GSK and a consultant for both Ethicon and Covidien.

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Joh, YG., Lindsetmo, RO., Stulberg, J. et al. Standardized Postoperative Pathway: Accelerating Recovery after Ileostomy Closure. Dis Colon Rectum 51, 1786–1789 (2008). https://doi.org/10.1007/s10350-008-9399-9

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  • DOI: https://doi.org/10.1007/s10350-008-9399-9

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