THE RELATIONSHIP BETWEEN HIGH-OUTPUT STOMA, POSTOPERATIVE ILEUS, AND READMISSION AFTER RECTAL CANCER SURGERY WITH DIVERTING ILEOSTOMY.
NAA LEE*, Soo Young Lee, Hyeong Rok Kim
Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea, Hwasun-eup, Hwasun-gun, Jeollanam-do, Korea (the Republic of)
Aim: Patients with high-output stoma (HOS) suffer from dehydration, which is the main cause of readmission after diverting ileostomy creation. This study aimed to evaluate the relationship between HOS, postoperative ileus (POI), and readmission after rectal cancer surgery with diverting ileostomy.
Method: We retrospectively reviewed prospectively collected database of rectal cancer patients, and included 302 patients who underwent restorative resection with diverting ileostomy between January 2011 and December 2015. Patients with distant metastasis were excluded. HOS was defined as stoma with output of more than 2000 mL/day. POI was defined as a delayed food intake with clinical and radiologic findings of small bowel obstruction within 7 days postoperatively. We analyzed predictive factors for POI and readmission after rectal cancer surgery with diverting ileostomy, focusing on the existence of HOS.
Results: Forty-eight (15.9%) had HOS during hospital stay, and 41 (13.6%) patients experienced POI. HOS was associated with POI (45.8% vs. 7.5%, p < 0.001), which remained significant after adjustment of confounding factors (adjusted odds ratio [OR] = 9.140, 95% confidence interval [CI] 4.323-19.327, p < 0.001). The all-cause readmission rate was 16.9% (51/302). Of the readmission, 19 (6.3%) suffered ileus, and 20 (6.6%) were diagnosed with acute kidney injury. HOS was associated with all-cause readmission (27.1% vs. 15.0%, p = 0.040), while POI was associated with all-cause readmission (34.1% vs. 14.2%, p = 0.002) and readmission with ileus (17.1% vs. 4.6%, p = 0.007). POI was an independent risk factor for all-cause readmission (adjusted OR = 2.640, 95% CI 1.162-6.001, p = 0.020) and readmission with ileus (adjusted OR = 3.869, 95% CI 1.387-10.792, p = 0.010).
Conclusion: HOS was associated with POI, resulting in readmission especially by subsequent ileus, in patients with diverting stoma. Patients with HOS should be managed more carefully as to whether they would experience POI and readmission.
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