eP702 - Predicting Post-Operative Outcomes in Patients Undergoing Loop Ileostomy Reversal: Analyzing the National Inpatient Sample 2015-2019

Purpose/Background: Loop ileostomy reversal is a common, and often straightforward, operation; hence multiple centers are developing early discharge protocols for patients undergoing ileostomy reversal. However, studies have shown post-operative complication rates ranging between 15-25%, with limited data identifying predictors of postoperative outcomes. This study uses the National Inpatient Sample (NIS) to address two aims. First, we assess the demographics and outcomes of patients undergoing loop ileostomy reversal in the Unites States. Second, we aim to identify predictors of postoperative morbidity among patients undergoing loop ileostomy reversal.Methods/Interventions: A retrospective analysis of the NIS from September 1st, 2015 to December 31st, 2019 was performed to identify adult patients who underwent loop ileostomy reversal following resection and proximal diversion for colorectal cancer, inflammatory bowel disease or diverticular disease. The primary outcomes were overall post-operative morbidity and healthcare resource utilization (including costs, length of stay, and discharge disposition). Secondary outcomes were system specific morbidity, mortality, and intensive care admission. Univariable and multivariable regressions were utilized incorporating patient demographics (including age, sex, frailty status defined by the modified frailty index, Charlson comorbidity index, body mass index, race, socioeconomic status) and operative characteristics (including operative approach, urgency, hospital details).Results/Outcomes: In total, 644 patients (44.4% female, mean age 52.0 years) were included. All patients underwent elective ileostomy reversal. These were performed after operation for colorectal cancer (58.2%), inflammatory bowel disease (28.6%) and diverticular disease (13.2%). Most patients had low frailty as defined by the modified frailty index tool (96.1%), had a Charlson comorbidity index less than 5 (84.8%), had a body mass index less than 30 kg/m2 (94.9%), and underwent an open surgical procedure (95.3%). Post-operative complications were experienced by 14.4% of patients (including 3.6% leak rate), and mortality was low at 0.2%. Median length of stay was 3 days (IQR 2-5 days) and median hospitalization costs per patient were $34,391 USD (IQR $24,739-$51,443). On adjusted analysis, increasing age was predictive of higher overall post-operative morbidity (OR 1.04, CI 1.01-1.06, p = 0.008). None of the other measured variables were predictive of post-operative outcomes.Conclusion/

Discussion: Although loop ileostomy is a relatively simple procedure with low mortality rate, 14.4% of patients in this large database study experienced a post-operative complication. Aside from age, none of the variables in this large administrative database were largely predictive of postoperative outcomes. It is likely that differences in outcomes are driven by more granular patient data. Future research utilizing granular patient and provider details may assist in optimizing care for these patients.