title: Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme.
abstract: OBJECTIVE
  Stoma formation is a well-known cause for delayed discharge following colorectal surgery. This has been addressed by the enhanced recovery programme (ERP) preoperatively through stoma counselling sessions. These aim to promote independent stoma management post-operatively, thus expediting hospital discharge. We compared the numbers of patients with prolonged hospital stay secondary to delayed independent stoma management prior to and following the introduction of an enhanced recovery programme with preoperative stoma education.
  
  
  METHODS
  Data collection on patients undergoing anterior resection with the formation of a loop ileostomy was carried out retrospectively prior to ERP (January 2006 to August 2008) and prospectively following the introduction of ERP (September 2008 to October 2010). Comparisons were made in patients with prolonged hospital stay (defined as hospital stay of more than 5 days) secondary to stoma management.
  
  
  RESULTS
  Two hundred forty patients underwent elective anterior resection with the formation of a loop ileostomy, 120 prior ERP and 120 post-ERP. Average length of hospital stay was 14 days before ERP introduction, with a range of 7-25 days. The mean length of stay amongst the ERP patients was 8 days (p = 0.17), ranging from 3 to 17 days. Twenty-one patients in the pre-ERP group (17.5%) experienced postponed hospital discharge due to a delay in independent stoma management, compared to one patient experiencing such a delay after the introduction of ERP (0.8%, p < 0.0001).
  
  
  CONCLUSIONS
  Delayed discharge secondary to independent stoma management can be significantly reduced with preoperative stoma management teaching as part of an enhanced recovery programme.
authors.affiliation: Ashford and St. Peter's Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK.
authors.forename: Jenan
authors.initials: J
authors.lastname: Younis
authors.forename: Gisella
authors.initials: G
authors.lastname: Salerno
authors.forename: Daniela
authors.initials: D
authors.lastname: Fanto
authors.forename: Marios
authors.initials: M
authors.lastname: Hadjipavlou
authors.forename: Daniel
authors.initials: D
authors.lastname: Chellar
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Trickett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000401:mortality / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000193:education*; D020127:Recovery of Function; D054047:Surgical Stomas / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology