减少结直肠手术后因脱水导致的再入院：预防套餐的影响。

Reducing dehydration-induced readmissions post-colorectal surgery: the impact of a prevention bundle.

机构信息

Department of General Surgery, Koc University School of Medicine, Istanbul, Türkiye.

Department of General Surgery, Koc University Hospital, Istanbul, Türkiye.

出版信息

Int J Colorectal Dis. 2024 Sep 7;39(1):138. doi: 10.1007/s00384-024-04709-5.

DOI:10.1007/s00384-024-04709-5

PMID:39243310

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11380635/

Abstract

INTRODUCTION

Ileostomy, frequently created after colorectal resections, hinders the physiologic function of the colon and can lead to dehydration and acute kidney injury due to high stoma outputs. This study aimed to evaluate the effectiveness of preventive measures on ileostomy-induced dehydration and related readmissions in a high-volume unit.

METHODS

In this prospective cohort study at a high-volume colorectal surgery department in Turkiye, the Prospective Ileostomy-induced Dehydration Prevention Bundle Project (PIDBP) was assessed from March 2021 to March 2022. The study enrolled patients undergoing colorectal surgery with ileostomy and involved comprehensive inpatient stoma care, education, and a structured post-discharge follow-up. The follow-up included the "Hydration follow-up scale" to monitor ileostomy output and related complications. The primary outcome was the readmission rate due to dehydration-related complications. The patients receiving the bundle intervention were compared with patients treated in the preceding year, focusing on the effectiveness of interventions such as dietary adjustments, fluid therapy, and pharmacological management.

RESULTS

In the study, 104 patients were analyzed, divided into 54 pre-bundle and 50 bundle group patients, with no significant differences in patient characteristics. While the overall readmission rate due to dehydration was 12.5%, a significant reduction in dehydration-related readmissions was observed in the bundle group compared to the pre-bundle group (2% vs. 22%, p = 0.002). Univariate analysis identified high stoma output (> 800 ml/24 h) (p < 0.001), chronic renal failure (CRF) (p = 0.01), postoperative ileus (p = 0.03), higher ASA status (p = 0.04), extended hospital stays (p = 0.03), and small bowel resections (especially in J-pouch patients) (p < 0.001) as significant predictors of readmission. Multivariate analysis revealed that the mean ileostomy output before discharge was the sole significant predictor of dehydration-related readmission (OR 1.01), with an optimal cutoff of 877.5 ml/day identified with an area under the curve (AUC) of 0.947, demonstrating high sensitivity (92.3%) and specificity (86.8%) in predicting readmission risk.

CONCLUSION

The Prospective Ileostomy-induced Dehydration Prevention Bundle Project significantly reduced readmission rates after colorectal surgery.

摘要

简介

肠造口术常因结直肠切除术后而形成，会妨碍结肠的生理功能，并导致因高造口输出而发生脱水和急性肾损伤。本研究旨在评估大容量单位中预防措施对肠造口术引起的脱水和相关再入院的效果。

方法

在土耳其一家大容量结直肠外科病房进行的这项前瞻性队列研究中，评估了 2021 年 3 月至 2022 年 3 月的前瞻性肠造口术引起的脱水预防捆绑项目（PIDBP）。该研究纳入了接受结直肠手术伴肠造口术的患者，包括全面的住院造口护理、教育和结构化的出院后随访。随访包括“补液随访量表”以监测造口输出和相关并发症。主要结局是因脱水相关并发症而导致的再入院率。将接受捆绑干预的患者与前一年接受治疗的患者进行比较，重点关注饮食调整、液体疗法和药物管理等干预措施的效果。

结果

本研究共分析了 104 例患者，分为 54 例预捆绑组和 50 例捆绑组患者，患者特征无显著差异。尽管整体脱水再入院率为 12.5%，但捆绑组的脱水相关再入院率明显低于预捆绑组（2%比 22%，p=0.002）。单因素分析发现高造口输出（>800ml/24h）（p<0.001）、慢性肾衰竭（CRF）（p=0.01）、术后肠梗阻（p=0.03）、较高的ASA 状态（p=0.04）、延长的住院时间（p=0.03）和小肠切除术（特别是 J 袋患者）（p<0.001）是再入院的显著预测因素。多因素分析显示，出院前平均造口输出量是与脱水相关再入院的唯一显著预测因素（OR 1.01），最佳截断值为 877.5ml/天，曲线下面积（AUC）为 0.947，具有较高的敏感性（92.3%）和特异性（86.8%），可预测再入院风险。