BACKGROUND: Twenty-nine percent of postileostomy discharges are readmitted, most commonly because of dehydration. However, there is a lack of detailed data specifically evaluating factors associated with readmission with dehydration. In addition, patients with a history of an ileostomy have often been excluded from previous studies and therefore represent a group of understudied ileostomates. OBJECTIVE: This study aimed to evaluate factors available at discharge associated with 30-day readmission for dehydration, rather than all-cause readmissions. DESIGN: This was a retrospective cohort study. SETTING: Study patients received ileostomies at a tertiary academic medical center from 2014 to 2016. PATIENTS: Patients with a preexisting ileostomy that was not recreated per the operative note were excluded, whereas those who received a new ileostomy were included. MAIN OUTCOME MEASURE: The primary outcome measured was 30-day readmission for dehydration as defined by objective clinical criteria. RESULTS: A total of 262 patients underwent ileostomy creation and were discharged alive. Twenty-five percent were ≥65 years of age, 53% were men, 14% had a history of ileostomy, 18% had a creatinine >1.0 on discharge, and 26% had high ileostomy output at any time during the index admission. Among all ileostomates, the all-cause readmission rate was 30%. Mean days to readmission for any cause was 8.5, whereas for dehydration it was 11.6 days. Of the readmissions, 37% were readmitted with a diagnosis of dehydration, and dehydration was the sole reason in 26%. Among those with dehydration, the most common length of stay was 2 days. In multivariable logistic regression, 30-day readmission with dehydration was associated with older age, male sex, history of an ileostomy, high ileostomy output during index admission, and a discharge creatinine >1.0. LIMITATIONS: This study was limited by its retrospective design. CONCLUSIONS: Ileostomy dehydration efforts have focused on new ileostomy patients; however, our data suggest that patients with a history of an ileostomy are actually at risk for readmission with dehydration. Further studies aimed at the reduction of readmission with dehydration after ileostomy are warranted and should include patients with a history of an ileostomy. See Video Abstract at http://links.lww.com/DCR/A643.
BACKGROUND: Twenty-nine percent of postileostomy discharges are readmitted, most commonly because of dehydration. However, there is a lack of detailed data specifically evaluating factors associated with readmission with dehydration. In addition, patients with a history of an ileostomy have often been excluded from previous studies and therefore represent a group of understudied ileostomates. OBJECTIVE: This study aimed to evaluate factors available at discharge associated with 30-day readmission for dehydration, rather than all-cause readmissions. DESIGN: This was a retrospective cohort study. SETTING: Study patients received ileostomies at a tertiary academic medical center from 2014 to 2016. PATIENTS: Patients with a preexisting ileostomy that was not recreated per the operative note were excluded, whereas those who received a new ileostomy were included. MAIN OUTCOME MEASURE: The primary outcome measured was 30-day readmission for dehydration as defined by objective clinical criteria. RESULTS: A total of 262 patients underwent ileostomy creation and were discharged alive. Twenty-five percent were ≥65 years of age, 53% were men, 14% had a history of ileostomy, 18% had a creatinine >1.0 on discharge, and 26% had high ileostomy output at any time during the index admission. Among all ileostomates, the all-cause readmission rate was 30%. Mean days to readmission for any cause was 8.5, whereas for dehydration it was 11.6 days. Of the readmissions, 37% were readmitted with a diagnosis of dehydration, and dehydration was the sole reason in 26%. Among those with dehydration, the most common length of stay was 2 days. In multivariable logistic regression, 30-day readmission with dehydration was associated with older age, male sex, history of an ileostomy, high ileostomy output during index admission, and a discharge creatinine >1.0. LIMITATIONS: This study was limited by its retrospective design. CONCLUSIONS:Ileostomy dehydration efforts have focused on new ileostomy patients; however, our data suggest that patients with a history of an ileostomy are actually at risk for readmission with dehydration. Further studies aimed at the reduction of readmission with dehydration after ileostomy are warranted and should include patients with a history of an ileostomy. See Video Abstract at http://links.lww.com/DCR/A643.
Authors: Samantha Hendren; Kerry Hammond; Sean C Glasgow; W Brian Perry; W Donald Buie; Scott R Steele; Janice Rafferty Journal: Dis Colon Rectum Date: 2015-04 Impact factor: 4.585
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Bradley J Hensley; Robert N Cooney; Nicholas J Hellenthal; Christopher T Aquina; Katia Noyes; John R Monson; Kristin N Kelly; Fergal J Fleming Journal: Dis Colon Rectum Date: 2016-05 Impact factor: 4.585
Authors: Ian M Paquette; Patrick Solan; Janice F Rafferty; Martha A Ferguson; Bradley R Davis Journal: Dis Colon Rectum Date: 2013-08 Impact factor: 4.585
Authors: Joshua A Tyler; Justin P Fox; Sekhar Dharmarajan; Matthew L Silviera; Steven R Hunt; Paul E Wise; Matthew G Mutch Journal: Dis Colon Rectum Date: 2014-12 Impact factor: 4.585
Authors: David Yu Greenblatt; Sharon M Weber; Erin S O'Connor; Noelle K LoConte; Jinn-Ing Liou; Maureen A Smith Journal: Ann Surg Date: 2010-04 Impact factor: 12.969
Authors: Evangelos Messaris; Rishabh Sehgal; Susan Deiling; Walter A Koltun; David Stewart; Kevin McKenna; Lisa S Poritz Journal: Dis Colon Rectum Date: 2012-02 Impact factor: 4.585
Authors: Virginia O Shaffer; Tari Owi; Mathu A Kumarusamy; Patrick S Sullivan; Jahnavi K Srinivasan; Shishir K Maithel; Charles A Staley; John F Sweeney; Greg Esper Journal: J Am Coll Surg Date: 2017-02-20 Impact factor: 6.113
Authors: Tyler McKechnie; Yung Lee; Jeremy E Springer; Aristithes G Doumouras; Dennis Hong; Cagla Eskicioglu Journal: Int J Colorectal Dis Date: 2019-11-21 Impact factor: 2.571
Authors: Mauro Podda; Patricia Sylla; Gianluca Baiocchi; Michel Adamina; Vanni Agnoletti; Ferdinando Agresta; Luca Ansaloni; Alberto Arezzo; Nicola Avenia; Walter Biffl; Antonio Biondi; Simona Bui; Fabio C Campanile; Paolo Carcoforo; Claudia Commisso; Antonio Crucitti; Nicola De'Angelis; Gian Luigi De'Angelis; Massimo De Filippo; Belinda De Simone; Salomone Di Saverio; Giorgio Ercolani; Gustavo P Fraga; Francesco Gabrielli; Federica Gaiani; Mario Guerrieri; Angelo Guttadauro; Yoram Kluger; Ari K Leppaniemi; Andrea Loffredo; Tiziana Meschi; Ernest E Moore; Monica Ortenzi; Francesco Pata; Dario Parini; Adolfo Pisanu; Gilberto Poggioli; Andrea Polistena; Alessandro Puzziello; Fabio Rondelli; Massimo Sartelli; Neil Smart; Michael E Sugrue; Patricia Tejedor; Marco Vacante; Federico Coccolini; Justin Davies; Fausto Catena Journal: World J Emerg Surg Date: 2021-07-02 Impact factor: 5.469
Authors: Claudia Seifarth; Leonard N Augustin; Kai S Lehmann; Andrea Stroux; Johannes C Lauscher; Martin E Kreis; Christoph Holmer Journal: Front Surg Date: 2021-05-21
Authors: Marcin Zeman; Marek Czarnecki; Andrzej Chmielarz; Adam Idasiak; Maciej Grajek; Agnieszka Czarniecka Journal: World J Surg Oncol Date: 2020-08-14 Impact factor: 2.754