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Readmissions With Dehydration After Ileostomy Creation

Rethinking Risk Factors

Justiniano, Carla F., M.D., M.P.H.1; Temple, Larissa K., M.D., M.Sc.1; Swanger, Alex A., B.A.1; Xu, Zhaomin, M.D., M.P.H.1; Speranza, Jenny R., M.D.1; Cellini, Christina, M.D.1; Salloum, Rabih M., M.D.1; Fleming, Fergal J., M.D.1

doi: 10.1097/DCR.0000000000001137
Original Contributions: Benign
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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.

1 Department of Surgery, University of Rochester Medical Center, Rochester, New York

Funding/Support: The data capture and management through REDCap for the project described in this publication was supported by the University of Rochester CTSA award number UL1 RR024160 from the National Institutes of Health/National Center for Research Resources.

Financial Disclosures: None reported.

Correspondence: Carla F. Justiniano, M.D., M.P.H., Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642. E-mail: carla_justiniano@urmc.rochester.edu.

© 2018 The American Society of Colon and Rectal Surgeons