The safety and feasibility of early discharge following ileostomy reversal: a National Surgical Quality Improvement Program analysis

Abstract

Background: This study aimed to compare 30-day clinical outcomes following routine ileostomy reversal between patients that underwent early discharge (<24 h) and standard discharge (postoperative day [POD] 2 or 3).

Methods: A retrospective cohort analysis was conducted between 2005 and 2014 using the American College of Surgeons National Surgical Quality Improvement Program data set. All patients undergoing ileostomy reversal who were discharged on POD 0 or 1 (early discharge group [EDG]) versus POD 2 or 3 (standard discharge group [SDG]) were identified. The primary outcome was the 30-day adverse event rate. The secondary outcome was the 30-day readmission rate. A multivariate analysis was performed to determine the adjusted effect of early discharge as well as the predictors of adverse events and readmissions.

Results: The study population consisted of 355 and 5805 patients in the EDG and SDG, respectively. There were 19 (5.4%) 30-day adverse events in the EDG and 341 (5.8%) in the SDG. The EDG had 17 (4.8%) 30-day readmissions and the SDG had 294 (5.1%). The adjusted odds ratio for 30-day adverse events in the EDG was 0.95 (P = 0.83), and for 30-day readmissions, it was 1.01 (P = 0.96). Higher BMI, longer operative time, ASA ≥3, chronic steroid use along with a history of bleeding disorder were significant predictors for adverse events and readmissions.

Conclusions: Select patients discharged within 24 h of ileostomy reversal did not have a significantly higher rate of adverse events or readmissions compared to patients discharged on POD 2 or 3 following uncomplicated surgery. Predictors of adverse events and readmissions can guide the selection of patients suitable for early discharge.

Keywords: ACS-NSQIP; Early discharge; Ileostomy reversal; Morbidity; Readmission; Surgery.