Ileostomy closure in an enhanced recovery setting

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Enhanced Recovery Programmes

Background:

• Ileostomy closure often results in prolonged hospital stays, typically 5 days or more.
• Enhanced Recovery Programmes (ERP) aim to optimize patient recovery and reduce hospital length of stay (LOS).

Purpose of the Study:

• To evaluate the impact of introducing an ERP for ileostomy closure on hospital LOS.
• To determine if ERP affects morbidity and readmission rates following ileostomy closure.

Main Methods:

• A prospective database was used to collect data on consecutive patients undergoing elective ileostomy closure between October 2000 and March 2013.
• Enhanced recovery protocols were implemented in June 2010, creating two groups: pre-ERP and ERP.
• Demographic data, LOS, readmission, morbidity, and mortality were compared between the groups.

Main Results:

• A total of 145 patients were analyzed (37 ERP, 108 pre-ERP).
• No significant differences were observed in demographics, ASA grade, neoadjuvant therapy, operative time, BMI, antibiotic use, or closure method between groups.
• Readmission rates (5% vs 6.5%), morbidity (8% vs 10%), and mortality (0% vs 0%) were statistically similar.
• Median LOS was significantly shorter in the ERP group (2 days) compared to the pre-ERP group (4 days, P < 0.0001).
• Mean LOS was also significantly reduced in the ERP group (3.4 days) versus the pre-ERP group (5.6 days, P = 0.033).

Conclusions:

• Enhanced Recovery Programmes significantly reduce hospital length of stay for ileostomy closure.
• ERP implementation for ileostomy closure does not adversely affect patient morbidity or readmission rates.