Mohammed Alqahtani, MD, Richard Garfinkle, MD, Carol-Ann Vasilevsky, MD, Gabriela Ghitulescu, MD, Nancy Morin, MD, Julio Faria, MD, Marylise Boutros, MD. Sir Mortimer B. Davis Jewish General Hospital
INTRODUCTION: Although diverting loop ileostomy (DLI) creation is an effective strategy to mitigate the morbidity of anastomotic leaks, DLI is associated with complications requiring hospital readmission. Among these, dehydration is most commonly reported. The goal of this study was to identify the prevalence and risk factors for dehydration requiring readmission following DLI using a large, validated multicenter database.
METHODS: After institutional review board approval, we retrospectively reviewed the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database between 2012-2016. Adult patients (>18 years) who underwent DLI as part of colorectal cancer or inflammatory bowel disease (IBD) resection were identified based on ICD-9 and CPT codes. Patient demographics, comorbidities, operative and post-operative data were collected. Primary outcome was readmission for dehydration, defined as dehydration (276.51), volume depletion disorder (276.50) or lack of water (E904.2). Multiple logistic regression was used to identify predictors of readmission for dehydration following DLI.
RESULTS: Of 14,139 patients who met inclusion criteria, 2,192 (15.5%) with DLI were readmitted within the 30-day post-operative period. Among these, 214 (1.5%) were for dehydration, representing the second most common reason (10.5%) for readmission following organ space surgical site infection (22%). On univariate analysis, patients readmitted for dehydration were younger (52.6 vs. 58.5 years, p<0.001), less likely to have COPD (1.4% vs. 4.5%, p=0.042), and more likely to have IBD (59.8% vs. 34.4%, p<0.001), laparoscopic surgery (36.4% vs. 23.1%, p < 0.001), and pre-operative steroid use (25.2% vs. 18.4%, p=0.014). Patients readmitted for dehydration had longer mean operative time (269 vs. 211 min, p<0.001), shorter mean length of stay (7.6 vs. 8.9 days, p=0.023), and were more likely to have experienced a NSQIP-major morbidity (27.1% vs. 20.9%, p=0.032) during the index admission. On multivariable regression, only female gender (OR=1.37, 95%CI 1.04-1.81), IBD (OR=2.26, 95%CI 1.56-3.3), type of colorectal resection/reconstruction [ileoanal pouch reconstruction (OR=2.8, 95%CI 1.82-4.4) and total colectomy (OR=1.92, 95% CI 1.15-3.2); reference–partial colectomy], shorter length of stay (OR=1.03, 95%CI 1.003-1.06), operative time (OR=1.002, CI 1.001-1.003), and NSQIP-major morbidity (OR=1.58, 95%CI 1.14-2.2) were significant independent predictors of readmission for dehydration.
CONCLUSIONS: This study identified patient-related, operative and post-operative risk factors for readmission for dehydration following DLI creation. Female gender, IBD diagnosis, proximal stomas, longer operative time, shorter initial hospital stay, and major morbidity following DLI creation were independent predictors of readmission for dehydration. Initiatives aimed at reducing readmission for dehydration should focus on these patient subgroups.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95806
Program Number: S039
Presentation Session: Colorectal I
Presentation Type: Podium