Evaluating 30-Day Readmission Rates after Ileostomy Reversal
Catherine C. Beauharnais1, Nicholas M. Sweeney2, Jennifer S. Davids1, Karim Alavi1, Justin A. Maykel1, Paul R. Sturrock1
1Colorectal Surgery, UMass Memorial Medical Center, Worcester, Massachusetts, United States, 2Rutgers University, New Brunswick, New Jersey, United States
Objectives: Temporary ileostomies are often created to minimize anastomotic complications after colorectal resections. However, the potential morbidity of subsequent ileostomy reversal surgery may not be fully recognized, particularly in terms of readmissions. This analysis aims to evaluate 30-day readmission rates and to identify potential predictors of readmission after ileostomy closure.
Design: This was a retrospective cohort study of patients who underwent ileostomy closure between 2017 and 2020 at a single institution. Demographics, intraoperative and perioperative factors were collected by chart review, and were compared between readmitted and non-readmitted patients. Subjects" charts were reviewed up to 30 days post-operatively. Descriptive statistics and multivariable logistic regression were performed to determine factors associated with hospital readmission after ileostomy reversal.
Setting: Tertiary care academic medical center.
Patients: A total of 103 ileostomy reversal procedures were reviewed, of which 20% (n=21) were readmitted within 30 days. Patients with colostomies were excluded from this analysis. Our sample was primarily male (56.3%), of Caucasian race (82.5), with a median age of 58 years (IQR 47-64).
Main Outcome Measures: Rates of readmission after ileostomy closure
Results: Median time to readmission was 10 days, IQR 4-15. Readmitted patients were slightly older (median age 57, IQR 47-63 vs. 52, IQR 56-67, p<0.04) and had a longer length of stay after ileostomy reversal (median 5 days, IQR 4-6 vs. 3 days, IQR 2-6, p=0.03). There were no significant differences in sex, race, ethnicity, BMI, ASA class and indication for index surgery between the two groups. Eighteen patients (17%) experienced post-operative complications (i.e., ileus, anastomotic leak); such patients were more likely to be readmitted compared to their counterparts (55.6% vs. 11%, p <0.001). Primary reasons for readmission were intra-abdominal abscess (n=5, 5%), small bowel obstruction (n=3, 3%) and ileus (n=3, 3%). On multivariable analyses, factors associated with readmission included hospital length of stay >3 days (OR 3.2, 95% CI 1.1-9.8, p=0.04) and post-operative complications (OR 4.8, 95% CI 1.6-14.0, p=0.005).
Conclusion: Our data show that ileostomy closures are associated with high readmission rates. Patients with longer length of stay and complications at index admission are more likely to be readmitted within 30 days of ileostomy closure. These factors should be considered during decision-making for ileostomy creation, and post-operative management following closure.
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