Abstract
Purpose
In this study we evaluated the outcome of a standardized enhanced recovery program in patients undergoing ileostomy closure.
Methods
Forty-two patients underwent ileostomy closure by a single surgeon and were managed by a standardized postoperative care pathway. On the first postoperative day, patients received oral analgesia and a soft diet. Discharge was based on standard criteria previously published for laparoscopic colectomy patients. Results were recorded prospectively in an Institutional Review Board-approved database, including demographics, operative time, blood loss, complications, length of stay, and readmission data.
Results
The median operative time and blood loss were 60 minutes and 17.5 mL, respectively, and median hospital stay was 2 days. Twenty-nine patients (69 percent) were discharged by postoperative Day 2. The complication rate was 23.8 percent; complications included prolonged postoperative ileus (n = 3), early postoperative small-bowel obstruction (n = 1), mortality not related to ileostomy closure (n = 1), minor bleeding (n = 1), wound infection (n = 1), incisional hernia (n = 1), diarrhea (n = 1), dehydration (n = 1). The 30-day readmission rate was 9.5 percent (n = 4). Two patients had reoperation within 30 days for small-bowel obstruction and a wound infection.
Conclusions
Ileostomy closure patients managed with postoperative care pathways can have a short hospital stay with acceptable morbidity and readmission rates.
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Dr. Conor P. Delaney receives research funding, research honorarium, and is a consultant and speaker for Adolor and Ethicon Endosurgery; receives research funding, research honorarium and is a speaker for Covidien; receives research funding, research honorarium and is a consultant for WL Gore; receives honorarium and is a consultant for Global Medical Group and Wyeth.
Dr. Brad Champagne is a paid speaker for GSK and a consultant for both Ethicon and Covidien.
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Joh, YG., Lindsetmo, RO., Stulberg, J. et al. Standardized Postoperative Pathway: Accelerating Recovery after Ileostomy Closure. Dis Colon Rectum 51, 1786–1789 (2008). https://doi.org/10.1007/s10350-008-9399-9
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DOI: https://doi.org/10.1007/s10350-008-9399-9