Abstract
Background
Ileostomy surgery is associated with a high readmission rate, and care pathways to prevent readmissions have been proposed. However, the extent to which readmission rates have improved is unknown. This study examined rates of readmission and emergency department visits (“return to hospital,” or RTH) across hospitals in Michigan.
Methods
This was a retrospective cohort study of patients undergoing colorectal surgery with ileostomy formation from July 2012 to August 2017 in twenty Michigan Surgical Quality Collaborative (MSQC) hospitals. Primary outcome was RTH within 30 days of surgery. Multivariable logistic regression was used to identify risk factors for RTH. RTH rates over time were calculated, and hospitals’ risk-adjusted rates were estimated using a multivariable model. Hospitals were divided into quartiles by risk-adjusted RTH rates, and RTH rates were compared between quartiles.
Results
Of 982 patients, 28.5% experienced RTH. Rates of RTH did not decrease over time. Adjusted hospital RTH rates ranged from 9.4 to 43.3%. The risk-adjusted rate in the best-performing hospital quartile was 17.5% vs. 37.3% in the worst-performing quartile (p < 0.001). Hospitals that were outliers for ileostomy RTH were not outliers for colorectal resection RTH in general.
Conclusions
Rates of RTH following ileostomy surgery are high and vary between hospitals. This suggests inconsistent or ineffective use of pathways to prevent these events and potential for improvement. There is clear opportunity to standardize care to prevent RTH after ileostomy surgery.
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References
Gwen B. Turnbull R, BS. The Ostomy Files: Ostomy Statistics: The $64,000 Question. Ostomy Wound Management. 2003 6/1/2003;49(6).
Fish DR, Mancuso CA, Garcia-Aguilar JE, et al. Readmission After Ileostomy Creation: Retrospective Review of a Common and Significant Event. Ann Surg. 2017 Feb;265(2):379-87.
Glasgow MA, Shields K, Vogel RI, Teoh D, Argenta PA. Postoperative readmissions following ileostomy formation among patients with a gynecologic malignancy. Gynecologic oncology. 2014 Sep;134(3):561-5.
Hayden DM, Pinzon MC, Francescatti AB, et al. Hospital readmission for fluid and electrolyte abnormalities following ileostomy construction: preventable or unpredictable? J Gastrointest Surg. 2013 Feb;17(2):298-303.
Iqbal A, Sakharuk I, Goldstein L, et al. Readmission After Elective Ileostomy in Colorectal Surgery Is Predictable. JSLS. 2018 Jul-Sep;22(3).
Justiniano CF, Temple LK, Swanger AA, et al. Readmissions With Dehydration After Ileostomy Creation: Rethinking Risk Factors. Diseases of the colon and rectum. 2018 Nov;61(11):1297-305.
Li W, Stocchi L, Cherla D, et al. Factors associated with hospital readmission following diverting ileostomy creation. Tech Coloproctol. 2017 Aug;21(8):641-8.
Messaris E, Sehgal R, Deiling S, et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Diseases of the colon and rectum. 2012 Feb;55(2):175-80.
Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR. Readmission for dehydration or renal failure after ileostomy creation. Diseases of the colon and rectum. 2013 Aug;56(8):974-9.
Nagle D, Pare T, Keenan E, Marcet K, Tizio S, Poylin V. Ileostomy pathway virtually eliminates readmissions for dehydration in new ostomates. Diseases of the colon and rectum. 2012 Dec;55(12):1266-72.
Collaborative MSQ. 2019 MSQC Program Manual. Available at: https://reports.msqc.org/Registry/content/resources?menuId=3025. Accessed March 6, 2019, 2019.
Cross IB. Inpatient hospital readmission policy changes: Frequently asked questions. Available at: http://provcomm.ibx.com/ProvComm/ProvComm.nsf/0/0a79cfe370afd5d1852581670054a350/$FILE/IBC_Inpatient%20readmissions%20FAQ_20170816.pdf. Accessed October 7, 2018.
CMS.gov. Readmissions Reduction Program (HRRP). Available at: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html. Accessed October 7, 2018.
van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ. 2011 Apr 19;183(7):E391-402.
Shaffer VO, Owi T, Kumarusamy MA, et al. Decreasing Hospital Readmission in Ileostomy Patients: Results of Novel Pilot Program. J Am Coll Surg. 2017 Apr;224(4):425-30.
Acknowledgments
We are grateful for the participation of the MSQC hospitals, their MSQC nurses, and their surgeon champions.
Funding
There was no direct grant support for this study, but several authors have research support:
- Dr. Hendren receives financial support for research from the American Society of Colon and Rectal Surgeons Research Foundation.
- Dr. Vu receives financial support for research from the Ruth L Kirschstein National Research Service Award (1F32DK115340-01A1).
- Dr. Suwanabol receives funding for research from the Society for Surgery of the Alimentary Tract and the American Society of Colon and Rectal Surgeons Research Foundation, and the American College of Surgeons.
- Dr. Hardiman receives funding from the National Cancer Institute, K08CA190645.
- The Michigan Surgical Quality Collaborative (the setting and data source for this research study) is funded by Blue Cross and Blue Shield of Michigan (BCBSM). By agreement, BCBSM is not provided with individual hospital performance data but sees only aggregate and de-identified data. There was no influence from BCBSM in the study design, data collection or analysis, writing, or decision to submit this work for publication.
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SK and KH designed the study, drafted and revised the work, approved it to be published, and agreed to be accountable to all aspects of the work. JV, PS, and NK contributed the analysis and interpretation of data, revised the work critically, approved it to be published, and agreed to be accountable to all aspects of the work.
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Meeting Presentation: American Society of Colon and Rectal Surgeons Annual Meeting, Nashville, TN, poster presentation. May 19–23, 2018.
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Hendren, S., Vu, J., Suwanabol, P. et al. Hospital Variation in Readmissions and Visits to the Emergency Department Following Ileostomy Surgery. J Gastrointest Surg 24, 2602–2612 (2020). https://doi.org/10.1007/s11605-019-04407-6
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DOI: https://doi.org/10.1007/s11605-019-04407-6