BACKGROUND: In UK in 2010-2011, 4,463 ileostomy closures were performed (35,442 bed days) with a median inpatient stay of 5 days (Hospital Episode Statistics data). This seems anomalous when there are reports of 23-h stay colectomies. We present our early experience of 23-h discharge for loop ileostomy closures. METHODS: A specific patient journey/pathway for 23-h discharge following loop ileostomy closure was implemented at a single UK institution between August 2011 and April 2012. Follow-up was by telephone contact 24-48 h postdischarge and by routine outpatient appointment, and patients were also provided with a 24-h contact point in case of emergency. RESULTS: Twenty-three patients were included (18 male patients; median age, 63 years; range, 28-78 years). Fifteen were discharged within 23 h. The remaining 8 patients were all discharged within 48 h of surgery. Four patients were readmitted with superficial wound infection (1), slight wound discharge (1), Clostridium difficile diarrhoea (1) and an anastomotic leak 8 days after surgery (1). Median length of follow-up was 3 months (range, 1-10 months). CONCLUSIONS: A specific 23-h discharge protocol for loop ileostomy closures is feasible and safe. Improved primary care and out-of-hours hospital support would have prevented both minor wound complications requiring readmission. The anastomotic leak presented at postoperative day 8 and would have occurred in the community even if a standard protocol was used. Additional patient information and support via stoma care have been introduced to build on our experience, and 23-h stay has been introduced as standard care.
BACKGROUND: In UK in 2010-2011, 4,463 ileostomy closures were performed (35,442 bed days) with a median inpatient stay of 5 days (Hospital Episode Statistics data). This seems anomalous when there are reports of 23-h stay colectomies. We present our early experience of 23-h discharge for loop ileostomy closures. METHODS: A specific patient journey/pathway for 23-h discharge following loop ileostomy closure was implemented at a single UK institution between August 2011 and April 2012. Follow-up was by telephone contact 24-48 h postdischarge and by routine outpatient appointment, and patients were also provided with a 24-h contact point in case of emergency. RESULTS: Twenty-three patients were included (18 male patients; median age, 63 years; range, 28-78 years). Fifteen were discharged within 23 h. The remaining 8 patients were all discharged within 48 h of surgery. Four patients were readmitted with superficial wound infection (1), slight wound discharge (1), Clostridium difficilediarrhoea (1) and an anastomotic leak 8 days after surgery (1). Median length of follow-up was 3 months (range, 1-10 months). CONCLUSIONS: A specific 23-h discharge protocol for loop ileostomy closures is feasible and safe. Improved primary care and out-of-hours hospital support would have prevented both minor wound complications requiring readmission. The anastomotic leak presented at postoperative day 8 and would have occurred in the community even if a standard protocol was used. Additional patient information and support via stoma care have been introduced to build on our experience, and 23-h stay has been introduced as standard care.
Authors: James P Taylor; Miloslawa Stem; Sophia Y Chen; David Yu; Sandy H Fang; Susan L Gearhart; Bashar Safar; Jonathan E Efron Journal: J Gastrointest Surg Date: 2018-10-22 Impact factor: 3.452