How to dramatically reduce dehydration-related readmission in patients undergoing restorative surgery with diverting ileostomy for ulcerative colitis.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2024-09-22 DOI:10.1007/s10151-024-03001-6

M Mineccia, A Valenti, P Massucco, S Dagatti, S Perotti, F Fazio, A Ferrero

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Abstract

Background: Patients affected by ulcerative colitis (UC) often require surgery, involving two or three-stage procedures, including ileostomy creation. While ileostomy has some advantages, it can lead to complications, such as dehydration. The aim of this study was to evaluate the impact of a new individualized stoma-therapeutic-care-pathway (STCP) on dehydration-related readmissions. Secondary endpoints were stoma-related complications.

Methods: The study compares two series of consecutive patients with UC undergoing diverting ileostomy during restorative ileo-pouch-anal-anastomosis. The STCP group consists of patients enrolled from January 2020 to December 2021 who followed the pathway. The older group was selected from 2015 to 2017 (control group). Clinical data were collected, including patient characteristics, hospital stay, complications, and readmissions. The study was approved by the local institutional review board.

Results: Overall, 30-day dehydration-related readmission occurred in one (1.4%) versus nine (15.3%) patients in the STCP group versus control group, respectively (p = 0.005). In-hospital peristomal skin complications were significantly lower in STCP group (6 patients, 8.5%) versus control (35, 59.3%), as well as ostomy complications that occurred in 5 (7%) patients in the STCP group versus 8 (13.5%) in the control group (both p < 0.001). Ostomy complications reduced significantly in the STCP group after discharge (two patients, 2.8% versus eight, 13.5%), p = 0.001, and after 30-days (three patients, 4.2% versus five, 8.5%).

Conclusions: This study underscores the effectiveness of STCP in reducing dehydration-related readmissions and stoma-related complications in patients with UC undergoing stoma creation. It emphasizes the significance of patient education, close follow-up, and multidisciplinary care. Further research and standardized stoma education are essential.

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如何大幅减少因溃疡性结肠炎接受回肠造口术修复手术的患者因脱水而再次入院的情况。

背景：溃疡性结肠炎（UC）患者通常需要进行手术，包括两阶段或三阶段手术，其中包括回肠造口术。虽然回肠造口术有一些优点，但也可能导致脱水等并发症。本研究旨在评估新型个体化造口治疗护理路径（STCP）对脱水相关再住院率的影响。次要终点是造口相关并发症：该研究比较了两组连续接受回肠造口术的 UC 患者。STCP 组由 2020 年 1 月至 2021 年 12 月期间入组并遵循该路径的患者组成。年龄较大的一组选自2015年至2017年（对照组）。研究收集了临床数据，包括患者特征、住院时间、并发症和再入院情况。研究获得了当地机构审查委员会的批准：总体而言，STCP组和对照组分别有1名（1.4%）和9名（15.3%）患者出现30天脱水相关再入院（P = 0.005）。STCP 组（6 名患者，8.5%）与对照组（35 名患者，59.3%）相比，院内造口周围皮肤并发症明显减少；STCP 组有 5 名患者（7%）出现造口并发症，对照组有 8 名患者（13.5%）（均为 p 结论：STCP 组与对照组相比，院内造口周围皮肤并发症明显减少：本研究强调了 STCP 在减少接受造口术的 UC 患者脱水相关再住院率和造口相关并发症方面的有效性。它强调了患者教育、密切随访和多学科护理的重要性。进一步的研究和标准化造口教育至关重要。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.