Angiotensin-Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) Use are Associated With Increased Readmission After Ileostomy Creation.

IF 1 4区医学 Q3 SURGERY American Surgeon Pub Date : 2024-12-10 DOI:10.1177/00031348241307396

Connie Y Gan, Shahrose Rahman, Shaun R Flerchinger, Jeffrey S Barton

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Abstract

Background: High output is a common cause for readmission after new ileostomy creation. The loss of sodium leads to compensatory activation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line therapy for hypertension in the United States. We hypothesized that concurrent use of ACEI/ARB increases the risk of readmission following new ileostomy creation due to the loss of this compensatory mechanism.

Methods: Patients undergoing ileostomy creation between 2009-2022 at an integrated managed health care system were included in this retrospective study. Primary outcomes were hospital readmission and ED visit within 30-days. Additional variables included ACEI/ARB use, ileostomy type, Charlson Comorbidity Index, additional antihypertensives at discharge (furosemide, hydrochlorothiazide, spironolactone, amlodipine, nifedipine, and diltiazem), and readmission diagnosis. Descriptive and advanced statistical analysis was completed with SPSS.

Results: Of 540 patients, 41.9% were readmitted or visited an ED within 30 days. There was no difference in readmission or ED visit based on age, gender, or ileostomy type. Patients discharged with ACEI/ARB (37.4% vs 25.5%, P = .005) and additional antihypertensives (37.2% vs 17.3%, P = .006) were at a higher risk for readmission.

Conclusions: Inhibition of RAAS is associated with increased risk for hospital readmission. In patients with hypertension undergoing ileostomy creation, individualized care plans are needed with earlier antimotility agent use or intravenous rehydration plans.

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血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）的使用与回肠造口术后再入院率增加有关。

背景：高输出量是新造回造口术后再入院的常见原因。钠的损失导致肾素-血管紧张素-醛固酮系统（RAAS）的代偿性激活。在美国，血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）是高血压的一线治疗药物。我们假设同时使用ACEI/ARB会由于失去这种代偿机制而增加新造回造口后再入院的风险。方法：回顾性研究2009-2022年间在综合管理卫生保健系统进行回肠造口术的患者。主要结局是30天内再次住院和急诊室就诊。其他变量包括ACEI/ARB使用、回肠造口类型、Charlson合并症指数、出院时额外的抗高血压药物（呋塞米、氢氯噻嗪、螺内酯、氨氯地平、硝苯地平和地尔硫卓）和再入院诊断。描述性和高级统计分析用SPSS软件完成。结果：在540例患者中，41.9%的患者在30天内再次入院或访问急诊室。年龄、性别或回肠造口类型在再入院或急诊科就诊方面没有差异。合并ACEI/ARB （37.4% vs 25.5%, P = 0.005）和其他抗高血压药物（37.2% vs 17.3%, P = 0.006）出院的患者再入院风险更高。结论：抑制RAAS与再入院风险增加有关。对于接受回肠造口术的高血压患者，需要个性化的护理计划，尽早使用抗运动药物或静脉补液计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.