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Twenty-three-hour stay loop ileostomy closures: a pilot study.
MedLine Citation:
PMID:  22936588     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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:
O Peacock; A Bhalla; J A Simpson; S Gold; N G Hurst; W J Speake; G M Tierney; J N Lund
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-31
Journal Detail:
Title:  Techniques in coloproctology     Volume:  -     ISSN:  1128-045X     ISO Abbreviation:  Tech Coloproctol     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9613614     Medline TA:  Tech Coloproctol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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.
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