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Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel?
BACKGROUND: Rectal resection surgery is often followed by a loop ileostomy creation. Despite improvements in surgical technique and development of enhanced recovery after surgery (ERAS) protocols, the readmission-rate after rectal resection is still estimated to be around 30%. The purpose of this st...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161575/ https://www.ncbi.nlm.nih.gov/pubmed/34044794 http://dx.doi.org/10.1186/s12893-021-01242-y |
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author | Van Butsele, Johanna Bislenghi, Gabriele D’Hoore, André Wolthuis, Albert M. |
author_facet | Van Butsele, Johanna Bislenghi, Gabriele D’Hoore, André Wolthuis, Albert M. |
author_sort | Van Butsele, Johanna |
collection | PubMed |
description | BACKGROUND: Rectal resection surgery is often followed by a loop ileostomy creation. Despite improvements in surgical technique and development of enhanced recovery after surgery (ERAS) protocols, the readmission-rate after rectal resection is still estimated to be around 30%. The purpose of this study was to identify risk factors for readmission after rectal resection surgery. This study also investigated whether elderly patients (≥ 65 years old) dispose of a distinct patient profile and associated risk factors for readmission. METHODS: This is a retrospective study of prospectively collected data from patients who consecutively underwent rectal resection for cancer within an ERAS protocol between 2011 and 2016. The primary study endpoint was 90-day readmission. Patients with and without readmission within 90 days were compared. Additional subgroup analysis was performed in patients ≥ 65 years old. RESULTS: A total of 344 patients were included, and 25% (n = 85) were readmitted. Main reasons for readmission were acute renal insufficiency (24%), small bowel obstruction (20%), anastomotic leakage (15%) and high output stoma (11%). In multivariate logistic regression, elevated initial creatinine level (cut-off values: 0.67–1.17 mg/dl) (OR 1.95, p = 0.041) and neoadjuvant radiotherapy (OR 2.63, p = 0.031) were significantly associated with readmission. For ileostomy related problems, elevated initial creatinine level (OR 2.76, p = 0.021) was identified to be significant. CONCLUSION: Recovery after rectal resection within an ERAS protocol is hampered by the presence of a loop ileostomy. ERAS protocols should include stoma education and high output stoma prevention. |
format | Online Article Text |
id | pubmed-8161575 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-81615752021-06-01 Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel? Van Butsele, Johanna Bislenghi, Gabriele D’Hoore, André Wolthuis, Albert M. BMC Surg Research Article BACKGROUND: Rectal resection surgery is often followed by a loop ileostomy creation. Despite improvements in surgical technique and development of enhanced recovery after surgery (ERAS) protocols, the readmission-rate after rectal resection is still estimated to be around 30%. The purpose of this study was to identify risk factors for readmission after rectal resection surgery. This study also investigated whether elderly patients (≥ 65 years old) dispose of a distinct patient profile and associated risk factors for readmission. METHODS: This is a retrospective study of prospectively collected data from patients who consecutively underwent rectal resection for cancer within an ERAS protocol between 2011 and 2016. The primary study endpoint was 90-day readmission. Patients with and without readmission within 90 days were compared. Additional subgroup analysis was performed in patients ≥ 65 years old. RESULTS: A total of 344 patients were included, and 25% (n = 85) were readmitted. Main reasons for readmission were acute renal insufficiency (24%), small bowel obstruction (20%), anastomotic leakage (15%) and high output stoma (11%). In multivariate logistic regression, elevated initial creatinine level (cut-off values: 0.67–1.17 mg/dl) (OR 1.95, p = 0.041) and neoadjuvant radiotherapy (OR 2.63, p = 0.031) were significantly associated with readmission. For ileostomy related problems, elevated initial creatinine level (OR 2.76, p = 0.021) was identified to be significant. CONCLUSION: Recovery after rectal resection within an ERAS protocol is hampered by the presence of a loop ileostomy. ERAS protocols should include stoma education and high output stoma prevention. BioMed Central 2021-05-27 /pmc/articles/PMC8161575/ /pubmed/34044794 http://dx.doi.org/10.1186/s12893-021-01242-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Van Butsele, Johanna Bislenghi, Gabriele D’Hoore, André Wolthuis, Albert M. Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel? |
title | Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel? |
title_full | Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel? |
title_fullStr | Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel? |
title_full_unstemmed | Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel? |
title_short | Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel? |
title_sort | readmission after rectal resection in the eras-era: is a loop ileostomy the achilles heel? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161575/ https://www.ncbi.nlm.nih.gov/pubmed/34044794 http://dx.doi.org/10.1186/s12893-021-01242-y |
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