Liu Chen, Bhat Sameer, O'Grady Gregory, Bissett Ian
Department of Surgery, University of Auckland, Auckland, New Zealand.
ANZ J Surg. 2020 Sep;90(9):1621-1626. doi: 10.1111/ans.16076. Epub 2020 Aug 17.
Ileostomy formation is a commonly performed procedure in colorectal surgery. The morbidity associated with ileostomies is substantial, particularly for unplanned hospital re-admissions and re-admissions with dehydration. Studies of post-ileostomy re-admissions from an Australasian institution are currently lacking. This retrospective study aimed to quantify the 60-day re-admission rate after ileostomy formation in a New Zealand tertiary centre and to determine the predictive factors.
The surgical database of Auckland City Hospital was searched for all patients aged ≥18 years with a new ileostomy formed between first January 2015 and first January 2019. Patient electronic medical records were reviewed to obtain data regarding the primary outcome of re-admissions within 60 days of discharge, as well as patient and operative variables. Multivariate regression analysis was performed to identify independent predictors of all-cause re-admissions and re-admissions with dehydration.
A total of 246 patients with 266 ileostomy formations were included. The 60-day re-admission rate was 29.3%, with dehydration present in 27.0% of these re-admissions. Renal impairment at discharge (odds ratio 2.819, 95% confidence interval 1.087-7.310) and the presence of at least one Clavien-Dindo 1 complication (odds ratio 2.268, 95% confidence interval 1.301-3.954) were independently associated with all-cause re-admission. The independent predictors of re-admission with dehydration were renal impairment at discharge, codeine prescribed on discharge, Charlson Comorbidity Index and body mass index.
Unplanned hospital re-admission following ileostomy formation is a significant issue in the New Zealand patient population. Some patient groups are at particularly high risk, such as those with renal impairment at discharge.
回肠造口术是结直肠手术中常见的操作。回肠造口术相关的发病率很高，尤其是计划外的再次入院以及因脱水导致的再次入院。目前缺乏来自澳大拉西亚机构的回肠造口术后再次入院情况的研究。这项回顾性研究旨在量化新西兰一家三级中心回肠造口术后60天的再次入院率，并确定预测因素。
在奥克兰市医院的手术数据库中搜索2015年1月1日至2019年1月1日期间所有年龄≥18岁且新形成回肠造口的患者。查阅患者电子病历，以获取出院后60天内再次入院这一主要结局的数据，以及患者和手术变量。进行多因素回归分析以确定全因再次入院和因脱水再次入院的独立预测因素。
共纳入246例患者的266次回肠造口术。60天再次入院率为29.3%，其中27.0%的再次入院患者存在脱水情况。出院时肾功能损害（比值比2.819，95%置信区间1.087 - 7.310）和至少出现1种Clavien-Dindo 1级并发症（比值比2.268，95%置信区间1.301 - 3.954）与全因再次入院独立相关。因脱水再次入院的独立预测因素为出院时肾功能损害、出院时开具可待因、Charlson合并症指数和体重指数。
回肠造口术后计划外的再次入院在新西兰患者群体中是一个重要问题。一些患者群体风险特别高，比如出院时肾功能损害的患者。
