title: Postoperative readmissions following ileostomy formation among patients with a gynecologic malignancy.
abstract: OBJECTIVE
  Ileostomy results in a relatively poorer water reabsorption and is associated with dehydration and renal injury. These problems may be exacerbated in the setting of gynecologic cancers owing to both patient and disease-related factors. We evaluated the rate and reasons for hospital readmission within 30 days of ileostomy creation in patients with a gynecologic malignancy.
  
  
  METHODS
  We performed a retrospective review of women with gynecologic malignancies who underwent ileostomy creation between 2002 and 2013.
  
  
  RESULTS
  Fifty-three patients were eligible for analysis. The mean age was 63.3 years. Most patients had ovarian cancer (86.5%). Indications for ileostomy included small bowel obstruction (45.3%), as part of primary debulking (18.9%), or treatment of an anastomotic leak (15.1%). The 30-day readmission rate was 34%. Co-morbid diseases such as hypertension (p=0.008) and chronic kidney disease (p=0.010) were more common among women who were readmitted. The most common reasons for readmission were dehydration (38.9%) and acute renal failure (33.3%); women readmitted for these conditions had higher average serum creatinine levels at initial postoperative discharge (1.00 mg/dL versus 0.71 mg/dL, p=0.017) than women who did not require readmission. Readmitted women had a trend toward shorter overall survival (0.41 years versus 1.67 years, p=0.061).
  
  
  CONCLUSIONS
  Readmission rates for gynecologic oncology patients undergoing ileostomy were similar to, but higher than those previously reported in the colorectal literature. In our population, patients with preexisting cardiovascular or renal disease were at the highest risk of readmission and may benefit from preemptive strategies to decrease high ostomy output and dehydration.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Glasgow
authors.affiliation: Maricopa Medical Center and St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Shields
authors.affiliation: Masonic Cancer Center, Biostatistics and Bioinformatics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Rachel Isaksson
authors.initials: RI
authors.lastname: Vogel
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Teoh
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA. Electronic address: argenta@umn.edu.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Argenta
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007081:Ileostomy; D007410:Intestinal Diseases / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000150:complications
keywords: Gynecologic malignancy; Ileostomy; Readmission