Addressing a Common Complication After Ileostomy Creation: A Multidisciplinary Program to Decrease Readmission for Dehydration

Kong D, Lin S, Karagkounis G, Abbass MA, Widmar M, Pappou E, Smith JJ, Nash GM, Weiser MR, Paty PB, Garcia-Aguilar J and Wei IH

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA

^*Correspondance to: Iris H. Wei 

 PDF  Full Text DOI: 10.25107/2474-1647.3733

Abstract

Objective: To evaluate the impact of a multidisciplinary program on dehydration risk after ileostomy creation.
Background: 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.
Methods: 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.
Results: 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).
Conclusions: 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.

Keywords

Ileostomy; Dehydration; Readmission

Cite the article

Kong D, Lin S, Karagkounis G, Abbass MA, Widmar M, Pappou E, et al. Addressing a Common Complication After Ileostomy Creation: A Multidisciplinary Program to Decrease Readmission for Dehydration. Clin Surg. 2025; 10: 3733..