Colon and Rectal Surgery Associates, Ltd, St. Paul, Minnesota.
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Dis Colon Rectum. 2019 Mar;62(3):363-370. doi: 10.1097/DCR.0000000000001286.
Hospital readmission is common after ileostomy formation and frequently associated with dehydration.
This study was conducted to evaluate a previously published intervention to prevent dehydration and readmission.
This is a randomized controlled trial.
This study was conducted in 3 hospitals within a single health care system.
Patients undergoing elective or nonelective ileostomy as part of their operative procedure were selected.
Surgeons, advanced practice providers, inpatient and outpatient nurses, and wound ostomy continence nurses participated in a robust ileostomy education and monitoring program (Education Program for Prevention of Ileostomy Complications) based on the published intervention. After informed consent, patients were randomly assigned to a postoperative compliance surveillance and prompting strategy that was directed toward the care team, versus usual care.
Unplanned hospital readmission within 30 days of discharge, readmission for dehydration, acute renal failure, estimated direct costs, and patient satisfaction were the primary outcomes measured.
One hundred patients with an ileostomy were randomly assigned. The most common indications were rectal cancer (n = 26) and ulcerative colitis (n = 21), and 12 were emergency procedures. Although intervention patients had better postdischarge phone follow-up (90% vs 72%; p = 0.025) and were more likely to receive outpatient intravenous fluids (25% vs 6%; p = 0.008), they had similar overall hospital readmissions (20.4% vs 19.6%; p = 1.0), readmissions for dehydration (8.2% vs 5.9%; p = 0.71), and acute renal failure events (10.2% vs 3.9%; p = 0.26). Multivariable analysis found that weekend discharges to home were significantly associated with readmission (OR, 4.5 (95% CI, 1.2-16.9); p = 0.03). Direct costs and patient satisfaction were similar.
This study was limited by the heterogeneous patient population and by the potential effect of the intervention on providers taking care of patients randomly assigned to usual care.
A surveillance strategy to ensure compliance with an ileostomy education program tracked patients more closely and was cost neutral, but did not result in decreased hospital readmissions compared with usual care. See Video Abstract at http://links.lww.com/DCR/A812.
肠造口术后常发生住院再入院，且常伴有脱水。
本研究旨在评估一项预防脱水和再入院的已发表干预措施。
这是一项随机对照试验。
该研究在单一医疗系统内的 3 家医院进行。
接受择期或非择期肠造口术作为手术一部分的患者入选。
外科医生、高级实践提供者、住院和门诊护士以及伤口造口失禁护士参与了一项基于已发表干预措施的强大肠造口教育和监测计划（预防肠造口并发症教育计划）。在获得知情同意后，患者被随机分配到术后依从性监测和提示策略组，该策略针对护理团队，而不是常规护理。
出院后 30 天内计划外住院再入院、因脱水、急性肾衰竭、估计直接成本和患者满意度。
100 例肠造口患者被随机分配。最常见的适应症是直肠癌（n = 26）和溃疡性结肠炎（n = 21），12 例为急症手术。尽管干预组患者出院后电话随访更好（90%比 72%；p = 0.025），更有可能接受门诊静脉补液（25%比 6%；p = 0.008），但两组总体住院再入院率（20.4%比 19.6%；p = 1.0）、因脱水的再入院率（8.2%比 5.9%；p = 0.71）和急性肾衰竭事件发生率（10.2%比 3.9%；p = 0.26）无显著差异。多变量分析发现，周末出院回家与再入院显著相关（OR，4.5（95%CI，1.2-16.9）；p = 0.03）。直接成本和患者满意度相似。
本研究受到患者人群异质性和干预措施对随机分配至常规护理的患者的潜在影响的限制。
监测策略可确保肠造口教育计划的依从性，密切跟踪患者情况且成本中性，但与常规护理相比，并未降低住院再入院率。[视频摘要可在 http://links.lww.com/DCR/A812 查看]
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