Readmissions after ileostomy closure: cause to revisit a standardized enhanced recovery pathway?

BACKGROUND: Our objective was to evaluate ileostomy reversal patients managed with a standardized enhanced recovery pathway to identify factors associated with readmissions.

METHODS: Prospective review database identified ileostomy reversal patients. Variables for the index admission and readmission were evaluated.

RESULTS: Three hundred thirty-two patients were analyzed. The primary diagnosis was colorectal cancer (57.6%). Thirteen percent of the patients were discharged by postoperative day (POD) 1, 47% by POD 2, and 65% by POD 3. The complication rate was 16.8%. The main complication was ileus/small bowel obstruction (n = 27). Thirty-day readmission rate was 12.4% (n = 41); small bowel obstruction (n = 27) was the most frequent readmission diagnosis. The median readmission POD was 7. Only 1 patient had a follow-up visit before readmission. The median readmission length of stay was 4 days.

CONCLUSIONS: Most ileostomy reversal readmissions occur before the first follow-up and stem from preventable causes. An enhanced recovery pathway modification may improve outcomes and utilization in this group.