Hospital readmission rates after ileal pouch-anal anastomosis.

PURPOSE: The goal of this study was to determine the unplanned hospital readmission rate following ileal pouch-anal anastomosis, prior to loop ileostomy closure.
METHODS: Patients undergoing ileal pouch-anal anastomosis over a five-year period were included in this retrospective study. Unplanned readmissions and readmission diagnoses were compiled. Gender, age, type of disease, duration of illness, elective vs. urgent surgical indication, operative method, steroid use, American Society of Anesthesiologists score, and regional anesthesia use at initial ileal pouch-anal anastomosis were evaluated as potential factors for readmission. Total length of stay was compared between patients readmitted and not readmitted.
RESULTS: One hundred and ninety-five patients underwent ileal pouch-anal anastomosis with diverting ileostomy. Fifty-nine patients (30 percent) required readmission. Forty-one patients had a single readmission, and 18 patients had at least 2 readmissions. Small bowel obstruction (28/86) and pelvic sepsis/ anastomotic leak (28/86) were the most common diagnoses upon readmission. Seventeen of 59 patients (28.8 percent) required surgical intervention following readmission and 42 patients were managed nonoperatively. Patients using systemic steroids at the time of surgery were more likely to be readmitted [47/116 (41 percent) vs. 12/79 (15 percent), P = 0.001). Length of stay (including initial admission for ileal pouch-anal anastomosis) for patients requiring readmission averaged 19.6 days vs. 9.6 days for patients not readmitted.
CONCLUSIONS: Hospital readmission after ileal pouch-anal anastomosis is common. We plan to institute a more intensive follow-up in an effort to prevent readmission of selected high-risk patients who might be effectively managed as outpatients.