Standardized postoperative pathway: accelerating recovery after ileostomy closure.
OBJECTIVE
In this study we evaluated the outcome of a standardized enhanced recovery program in patients undergoing ileostomy closure.


METHODS
Forty-two patients underwent ileostomy closure by a single surgeon and were managed by a standardized postoperative care pathway. On the first postoperative day, patients received oral analgesia and a soft diet. Discharge was based on standard criteria previously published for laparoscopic colectomy patients. Results were recorded prospectively in an Institutional Review Board-approved database, including demographics, operative time, blood loss, complications, length of stay, and readmission data.


RESULTS
The median operative time and blood loss were 60 minutes and 17.5 mL, respectively, and median hospital stay was 2 days. Twenty-nine patients (69 percent) were discharged by postoperative Day 2. The complication rate was 23.8 percent; complications included prolonged postoperative ileus (n = 3), early postoperative small-bowel obstruction (n = 1), mortality not related to ileostomy closure (n = 1), minor bleeding (n = 1), wound infection (n = 1), incisional hernia (n = 1), diarrhea (n = 1), dehydration (n = 1). The 30-day readmission rate was 9.5 percent (n = 4). Two patients had reoperation within 30 days for small-bowel obstruction and a wound infection.


CONCLUSIONS
Ileostomy closure patients managed with postoperative care pathways can have a short hospital stay with acceptable morbidity and readmission rates.
Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Yong-Geul
YG
Joh
Rolv-Ole
RO
Lindsetmo
Jonah
J
Stulberg
Vincent
V
Obias
Brad
B
Champagne
Conor P
CP
Delaney
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D020127:Recovery of Function; D013536:Suture Techniques; D016896:Treatment Outcome