eP438 - Ileostomy Closure in the Ambulatory Setting

Sunday, June 2, 2024

2:09 PM – 2:14 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Alexandra Wilson, DO

CRS Fellow
Swedish Medical Center
Swedish Hospital
Seattle, WA, United States

Disclosure information not submitted.

Author(s)

Douglas Morte, MD

MIS Fellow
Multicare Health System, Tacoma, WA
Multicare Health System
Lacey, WA, United States

Disclosure information not submitted.

Author(s)

AM

Adam Martorana, n/a

Medical Student
A.T. Still University School of Osteopathic Medicine
Renton, Washington, United States

Disclosure information not submitted.
Ruben M. Lesnick, MD (he/him/his)

General Surgery Resident
Swedish Medical Center
Seattle, WA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
CK

Callan Kosnik, n/a

PA-C
Multicare
Tacoma, Washington, United States

Disclosure information not submitted.
SP

Sunshine Pille, PA-C

Physician Assistant, Colorectal Surgery
Multicare Health System
Tacoma, Washington, United States

Disclosure information not submitted.
JS

James M. Scanlan, PhD

Scientific Writer
Swedish Center for Research and Innovation
Shoreline, Washington, United States

Disclosure information not submitted.

Senior Author(s)

Laila Rashidi, MD FASCRS (she/her/hers)

Colorectal Surgeon
Washington State University
Washington State University
Seattle, Washington, United States

Disclosure information not submitted.

Author(s)

MH

Melinda E. Hawkins, MD

Colon and Rectal Surgeon
Swedish Medical Center
Seattle, WA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Purpose/Background: Loop ileostomies are a common adjunct when performing low anterior resections for rectal cancer. Reversal commonly takes place 6-8 weeks postoperatively with a median hospital length of stay for 3-4 days. Our institution implemented enhanced recovery after surgery protocols (ERAS) allowing patients to leave the day of surgery. We will describe our patient population, ERAS Protocols, and identify factors associated with same day discharge versus prolonged length of stay (LOS).Methods/Interventions: We retrospectively reviewed patients from May 2020-Sept 2023. Our ERAS protocol consisted of patient education on length of stay and recovery at the pre-operative appointment, fascial injection of long-acting local anesthetic, and multi-modal post-operative pain control minimizing narcotic usage. Data analyzed included age, BMI, Diabetes, CAD, anti-coagulation use, rectal cancer, LOS, need for readmission, and narcotic use during hospital stay. Patients were divided into length of stay with categories of 0 days, 1 day, and >2 days. ANOVA and Chi-Square tests were used to determine factors influencing LOS. SPSS 22 was used for statistics.Results/Outcomes: Sixty six patients underwent an ileostomy reversal. 30 patients discharged POD 0, 29 patients left POD 1, and 7 patients remained 2+ days. There were 35 male and 30 female patients, with average age of 55 (p=.685) and average BMI of 28.4 (P=.715). Operative time was 58 mins for 0 day LOS (p=.004), 64 mins for 1 day LOS (p=.004), and 87 mins for >2 day LOS (p=.004). Comorbidities included diabetes (n=7, p=.715), coronary artery disease (n=6, p=724), anticoagulant use (n=17, p=004), and rectal cancer (n=53, p=.626). Reasons for prolonged length of stay included nausea (n=2), ileus (n=1), pain (n=8). Twelve patients required readmission: nonsurgical (gastroenteritis, inguinal hernia pain, and leg cellulitis, n=3), SBO (n=4), AKI (n=1), Infection (n=1), Hematochezia (n=1), Dehiscence (n=1). Fifty nine patients required narcotics during their admission with an average oral morphine equivalent of 210mg (p=.243) or IV morphine equivalent of 70mg (P=.243). Statistically significant factors affecting length of stay were pain (p=0.001), operating time (p=0.005), and use of anticoagulants (p=0.005).Conclusion/

Discussion: The implementation of ERAS protocols has dramatically changed our postoperative care for patients undergoing surgery. We have published prior studies from our institution that detail the merits of ERAS protocols with regards to same day discharge for colectomies. This study shows that these same principles can be implemented on open ileostomy closures as well. Pain, extended operative time, and need for anticoagulant therapy were associated with increased LOS. This study demonstrates that ambulatory ileostomy reversal can be safely offered to patients.