Addressing a common complication after ileostomy creation: a multidisciplinary program to decrease readmission for...

To evaluate the impact of a multidisciplinary program on dehydration risk after ileostomy creation.

Dehydration after ileostomy creation is a significant complication and the most common reason for readmission. We implemented a multidisciplinary program to address this problem, including improved perioperative education and increasing wound ostomy and continence nurse (WOCN) support.

We queried patients who underwent ileostomy creation from 2010-2019. We evaluated patient characteristics (including sex, age, comorbidities), operative characteristics (including approach, class, duration, estimated blood loss), and perioperative characteristics (including WOCN consultation, antimotility agents, ileostomy output, length of stay [LOS], follow up, and adverse events). Primary outcome was 60-day readmission for dehydration. Univariate and multivariate logistic models were created to identify factors associated with dehydration.

Nine hundred and ninety-eight patients underwent ileostomy creation, with a median LOS of 6 days. The readmission rate for dehydration was 5.4% (vs 11.5% previously), with a median time to readmission of 8.5 days. Patients readmitted for dehydration had slightly higher ileostomy output prior to discharge (750 vs 500 mL/24h) and later post-operative follow up (13 vs 11 days). On multivariate analysis, risk factors associated with dehydration were diabetes (p = 0.001), open surgery (p = 0.001), adverse events (p < 0.001), and higher ileostomy output (p = 0.004).

Readmission for dehydration after ileostomy creation has significantly decreased with the implementation of a multidisciplinary program. A potential area of improvement is close follow up within 1 week for high-risk patients to identify and address early signs of dehydration.