A. A. Hart1, P. Goffredo3, M. O. Suraju2, N. Allievi2, A. Masson2, A. Khan4, S. Ahad2, I. Hassan2 1University Of Iowa,Carver College Of Medicine,Iowa City, IA, USA 2University Of Iowa,Department Of Surgery,Iowa City, IA, USA 3University Of Minnesota,Department Of Surgery,Minneapolis, MN, USA 4Raleigh General Hospital,Department Of Surgery,Beckley, WEST VIRGINIA, USA
Introduction: Due to a variety of intraabdominal pathologies, primary fecal diversion with an ileostomy or colostomy is sometimes necessary. Patients undergoing this procedure are at risk of increased morbidity and readmissions because of their new ostomy status and/or the underlying disease. The current study evaluated risk factors associated with hospital readmissions and the impact of perioperative morbidity among patients undergoing a diverting ileostomy or colostomy without resection.
Methods: Adult patients undergoing laparoscopic or open fecal diversion without resection [colostomy (CPT: 44188 and 44320) or ileostomy (CPT: 44187 and 44310)] where identified from the American College of Surgeons National Surgical Quality Improvement Program Participant User File (2016-2018). Primary end points were readmission within 30 days and pre- and post-discharge grade 3 complications.
Results: Among the total cohort of 7864 patients, 26% had an ileostomy, while 74% underwent a colostomy. Of these, 54% were performed laparoscopically. The median age was 61 years (IQR:51-71), and BMI was 25 (IQR:22-30), with 51% of patients being females. The median length of stay was 5 days (IQR:3-9) and the readmissions rates were 20% and 14% for ileostomy and colostomy, respectively. In multivariable analysis of the whole cohort, younger age, female gender, pre- or post-discharge grade 3 complications, and ileostomy were all independently associated with an increased risk of readmission (Table 1). Conversely, indications (colorectal cancer, diverticular disease, and Inflammatory Bowel Disease), surgical approach, and emergent surgery were not found to be significantly associated with higher readmission rates. Post-discharge grade 3 complications had the largest magnitude of effect for readmissions (OR:13.9, CI:11.14-17.22). Weight loss > 10%, ASA >2, and emergency surgery were independently associated with higher rates of post-discharge grade 3 complications. The risk of these complications was decreased by using laparoscopy.
Conclusion: In this large national cohort of patients, we identified high rates of readmissions among patients undergoing primary fecal diversion without resection. Ileostomy was independently associated with higher readmission rates. Post-discharge grade 3 complication was the strongest risk factor for readmissions, which in turn was associated with emergency surgery and patient comorbidities. These patients represent a high-risk group and should be considered for mitigating strategies.
