Robert Fearn, MRCP, MSc, MBChB, Swathi Rajagopal, MBBS. Homerton University Hospital NHS Foundation Trust
Background: Colorectal surgery for benign and malignant conditions commonly results in the formation of an excretory stoma with population prevalence rates as high as 2-4 per thousand. Ostomates are prone to complications, including acute kidney injury (AKI) and hospital readmissions. We aimed to quantify stoma output in the first 7 days following a new stoma formation in order to determine its relationship to acute kidney injury and readmissions.
Methods: We retrospectively analysed consecutive new stoma patients at our unit between August 2015-July 2017 using electronic records. Daily stoma output for the first 7 postoperative days was tabulated. We recorded biochemical evidence of acute kidney injury during index admission or up to 3 months post-discharge and readmission within 30 days.
Results: 67 new stoma patients were included, aged 20-88 years, median 61, 34 male. Colostomy formation was performed in 18 patients with 49 ileostomies. Documentation of stoma output was variable with on average 66% of patients having volume recorded on any given day. This appeared to be worse in days 1-2 (7.5% and 39% respectively) than days 3-7 (59-72%). Mean daily colostomy output over the first 7 days was 236ml/d (95% CI 117-355ml) whilst mean ileostomy output was 692ml/d (535-848ml). Colostomy output stabilised rapidly, whilst ileostomy output increased progressively throughout the first 7 postoperative days as can be seen in Chart 1. Twelve patients (18%) developed AKI during index admission. Length of stay was significantly greater in the AKI group at 34 (95% CI 30-38) days vs 15 (11-19) days. Highest daily stoma output was non significantly higher in the AKI group 1612ml (95% CI 636-2,588ml) vs 1,122 (857-1,387ml) as was mean daily stoma output at 800ml (337-1,263ml) vs 549ml (312-786ml) (Chart 2). Seventeen patients (25%) were readmitted for any reason, 7 (9%) specifically for AKI. In total 13 patients (19%) developed AKI within three months of their stoma surgery only 3 of whom had developed AKI during their index admission. All patients who developed AKI following their index admission were ileostomy patients.
Conclusion: Acute kidney injury in new stoma patients is associated with prolonged hospital stay and readmissions with associated morbidity and healthcare costs. Ileostomy patients are more likely to suffer these complications and elevated stoma output volumes during the index admission may signal those at most risk. This study underlines the importance of accurate monitoring of ostomy output. Improved training and emerging technologies may help to address this issue.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87450
Program Number: P733
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster