title: Hospital readmission for fluid and electrolyte abnormalities following ileostomy construction: preventable or unpredictable?
abstract: BACKGROUND
  Ileostomy creation has complications, including rehospitalization for fluid and electrolyte abnormalities. Although studies have identified predictors of this morbidity, readmission rates remain high.
  
  
  METHODS
  The researchers conducted a retrospective chart review of all patients with ileostomy creation at a tertiary institution from January 2008 to June 2011.
  
  
  RESULTS
  One hundred fifty-four patients (154) were included in this study; 71 (46.1 %) were female. Mean age was 49 ± 17.64 (range 16-91), and mean BMI was 26.9 ± 6.44 (range 13-52). The readmission rate for fluid and electrolyte abnormalities was 20.1 % for the study population; of those readmitted for all diagnoses, dehydration accounted for 40.7 % of all readmissions. Cancer was associated with readmission (χ(2) = 4.73, p = 0.03) as was neoadjuvant therapy (χ(2) = 9.20, p = 0.01). After multivariate analysis, only the use of anti-diarrheals and neoadjuvant therapy remained significant. High stoma output, adjuvant treatment, and postoperative complications were not significant.
  
  
  CONCLUSIONS
  Our study found that the use of anti-diarrheals and neoadjuvant therapy for rectal cancer were associated with readmission. Our findings imply that the use of anti-diarrheals may be a marker for patients at risk for fluid and electrolyte abnormalities; these patients should be strictly monitored at home. Our study also suggests consideration of avoidance of ileostomy creation or different discharge criteria for at-risk patients. Prospective studies focused on stoma monitoring after discharge may help reduce rehospitalizations for fluid and electrolyte abnormalities after ileostomy creation.
authors.affiliation: Division of Colon and Rectal Surgery, Loyola University Medical Center, 2160 South First Ave, Maywood, IL 60153, USA. dahayden@lumc.edu
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hayden
authors.forename: Maria C Mora
authors.initials: MC
authors.lastname: Pinzon
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Francescatti
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Edquist
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Malczewski
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Jolley
authors.forename: Marc I
authors.initials: MI
authors.lastname: Brand
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Saclarides
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001826:Body Fluids; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014883:Water-Electrolyte Imbalance / Q000209:etiology* / Q000517:prevention & control*; D055815:Young Adult