title: Readmissions after ileostomy closure: cause to revisit a standardized enhanced recovery pathway?
abstract: BACKGROUND
  Our objective was to evaluate ileostomy reversal patients managed with a standardized enhanced recovery pathway to identify factors associated with readmissions.
  
  
  METHODS
  Prospective review database identified ileostomy reversal patients. Variables for the index admission and readmission were evaluated.
  
  
  RESULTS
  Three hundred thirty-two patients were analyzed. The primary diagnosis was colorectal cancer (57.6%). Thirteen percent of the patients were discharged by postoperative day (POD) 1, 47% by POD 2, and 65% by POD 3. The complication rate was 16.8%. The main complication was ileus/small bowel obstruction (n = 27). Thirty-day readmission rate was 12.4% (n = 41); small bowel obstruction (n = 27) was the most frequent readmission diagnosis. The median readmission POD was 7. Only 1 patient had a follow-up visit before readmission. The median readmission length of stay was 4 days.
  
  
  CONCLUSIONS
  Most ileostomy reversal readmissions occur before the first follow-up and stem from preventable causes. An enhanced recovery pathway modification may improve outcomes and utilization in this group.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Swendseid
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Khan
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: Conor.Delaney@uhhospitals.org.
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D019091:Critical Pathways / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000502:physiology* / Q000601:surgery; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult
keywords: Colorectal surgery; Enhanced recovery pathways; Ileostomy; Patient outcomes; Readmission rates