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Risk Factors for Readmission after Ileostomy Creation: an NSQIP Database Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Ileostomy creation is associated with excess readmissions following colorectal surgery. This study identifies risk factors for readmission in patients undergoing ileostomy creation and identifies areas of clinical intervention to reduce readmission.

Methods

We used the NSQIP dataset including colectomy specific data to include 39,380 patients who underwent ileostomy creation between 2012 and 2017. We conducted univariate and multivariable analysis to identify predictors of surgery-related 30-day readmissions. Our multivariate model included surgery type (total abdominal colectomy, partial colectomy, enterectomy, or pelvic dissection), gender, age, race, ethnicity, preoperative renal failure, dialysis, transfusion, ascites, ventilator dependence, diabetes, ASA class, functional status, emergency case, SSI, wound disruption, postoperative renal insufficiency, postoperative sepsis, discharge destination, and wound class.

Results

A total of 5718 (14.52%) patients were readmitted within 30 days. After multivariate analysis, factors associated with readmission were gender, age, Hispanic ethnicity, dialysis, transfusion, ventilator dependence, diabetes, emergency case, SSI, postoperative renal insufficiency, postoperative sepsis, and discharge to a skilled facility. Patients who had enterectomy and partial colectomies were less likely to be readmitted than patients who had a pelvic procedure. Patients with postoperative renal insufficiency or renal failure were much more likely to be readmitted.

Conclusion

Factors associated with readmission included the type of procedure and postoperative complications such as SSI, sepsis, and renal failure. Efforts to reduce readmission should focus on patients undergoing concomitant pelvic procedures as well as avoidance and management of common complications in this group of patients.

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Acknowledgments

We would like to acknowledge our colleagues from Boston Medical Center Department of Surgery for their support and expertise in completing our manuscript.

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Authors and Affiliations

  1. General Surgery Department, Boston Medical Center, 88 East Newton C515, Boston, MA, 02118, USA

    Na Eun Kim

  2. Colon & Rectal Surgery and Colorectal Surgery Department, Boston Medical Center, Boston, MA, USA

    Jason F. Hall

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  1. Na Eun Kim
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Contributions

Dr. Na Eun Kim and Dr. Jason F Hall contributed to the design of the work and analysis of the data and drafted the manuscript including its revisions. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work and ensure that questions related to the accuracy of the work were appropriately investigated and resolved.

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Correspondence to Na Eun Kim.

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Presentations: Presented as a e-Poster #P250 in the American Society of Colon and Rectal Surgeons 6/10/2017–6/14/2017 in Seattle, WA, USA.

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The authors declare that they have no conflict of interest.

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Kim, N.E., Hall, J.F. Risk Factors for Readmission after Ileostomy Creation: an NSQIP Database Study. J Gastrointest Surg 25, 1010–1018 (2021). https://doi.org/10.1007/s11605-020-04549-y

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