title: Twenty-three-hour stay loop ileostomy closures: a pilot study.
abstract: BACKGROUND
  In UK in 2010-2011, 4,463 ileostomy closures were performed (35,442 bed days) with a median inpatient stay of 5 days (Hospital Episode Statistics data). This seems anomalous when there are reports of 23-h stay colectomies. We present our early experience of 23-h discharge for loop ileostomy closures.
  
  
  METHODS
  A specific patient journey/pathway for 23-h discharge following loop ileostomy closure was implemented at a single UK institution between August 2011 and April 2012. Follow-up was by telephone contact 24-48 h postdischarge and by routine outpatient appointment, and patients were also provided with a 24-h contact point in case of emergency.
  
  
  RESULTS
  Twenty-three patients were included (18 male patients; median age, 63 years; range, 28-78 years). Fifteen were discharged within 23 h. The remaining 8 patients were all discharged within 48 h of surgery. Four patients were readmitted with superficial wound infection (1), slight wound discharge (1), Clostridium difficile diarrhoea (1) and an anastomotic leak 8 days after surgery (1). Median length of follow-up was 3 months (range, 1-10 months).
  
  
  CONCLUSIONS
  A specific 23-h discharge protocol for loop ileostomy closures is feasible and safe. Improved primary care and out-of-hours hospital support would have prevented both minor wound complications requiring readmission. The anastomotic leak presented at postoperative day 8 and would have occurred in the community even if a standard protocol was used. Additional patient information and support via stoma care have been introduced to build on our experience, and 23-h stay has been introduced as standard care.
authors.affiliation: Division of Surgery, School of Graduate Entry Medicine and Health, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK. oliver.peacock@nhs.net
authors.forename: O
authors.initials: O
authors.lastname: Peacock
authors.forename: A
authors.initials: A
authors.lastname: Bhalla
authors.forename: J A
authors.initials: JA
authors.lastname: Simpson
authors.forename: S
authors.initials: S
authors.lastname: Gold
authors.forename: N G
authors.initials: NG
authors.lastname: Hurst
authors.forename: W J
authors.initials: WJ
authors.lastname: Speake
authors.forename: G M
authors.initials: GM
authors.lastname: Tierney
authors.forename: J N
authors.initials: JN
authors.lastname: Lund
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D010865:Pilot Projects; D013997:Time Factors