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Session: ePoster Monitor 3-Quality and Cost 2

eP306 - Initiation of an Anastomotic Leak Prevention Protocol Does Not Increase the Utilization of Diverting Ileostomies

Sunday, June 2, 2024
12:09 PM – 12:14 PM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Susan Campbell, MD (she/her/hers)

    Resident
    University of Vermont Medical Center
    Burlington, VT, United States

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

    • Author(s)

  • AL

    Aaron Lambert, M.D.

    General Surgery Resident
    University of Vermont Medical Center
    Burlington, Vermont, United States

    Disclosure information not submitted.

  • PC

    Peter W. Callas, PhD, MS

    Associate Professor
    University of Vermont
    Burlington, Vermont, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • PC

    Peter Cataldo, MD

    Samuel and Michelle Labow Professor of Colon and Rectal Surgery
    UVM
    Stowe, Vermont, United States

    Disclosure information not submitted.

Purpose/Background: Anastomotic leaks in colorectal surgery occur in 2-7% of cases, most commonly from coloanal anastomoses (10-20%), and impact functional outcomes while increase morbidity and mortality. Most often, leaks are detected 5-7 days postoperatively and up to half are discovered after discharge. Diverting ileostomies are used to mitigate the impact of leaks, though lead to additional complications such as dehydration, wound complications, need for reversal, etc. Our institution developed an Anastomotic Leak Prevention Protocol (ALPP) in 2015 to mitigate contributing factors to anastomotic leaks. This study looks at whether this protocol increased to rates of diverting ileostomy creation or changed patient outcomes.Methods/Interventions: A cohort was generated from our database including patients who received elective colorectal resections performed by a colorectal surgeon, had a primary anastomosis with or without diversion, between 7/1/2016 to 6/30/2019. A historical cohort with the same inclusion criteria was generated from 1/1/2014 to 6/30/2015, prior to the initiation of our Leak Prevention Bundle. Statistical analysis was completed with GraphPad 10. Descriptive statistics were generated, and Mann Whitney tests were used to detect differences in the pre and post ALPP groups for leak rates, 30-day ED visit rates, 30-day readmission rates, LOS, and SSI.Results/Outcomes: There were 148 patients in the pre ALPP (pre), and 325 patients in the post ALPP (post). Age, BMI, Pre-Operative albumin, UC, Crohn’s, DM and insulin dependence, steroid use, COPD, and sex were similar between groups. Post APPL, there were more patients with colorectal cancer diagnoses 46.8% vs 31.1% pre bundle (p=0.0014). There was no significant difference in ileostomy creation rates: pre 40.5%; post 40.3% (p=0.9622). 30-Day readmission rates were not significantly different: pre 13.5%; post 11.1% (p=0.4478). 30-Day ED visits were not significantly different between cohorts: pre 4.1%; post 2.8% p=0.4609). Length of stay was not significantly different: pre 5.26 days; post 5.08 days (p=0.3958). Surgical site infections decreased significantly after bundle initiation: pre 16.9%; post 2.8% (p=0.0001). Anastomotic leaks significantly decreased after bundle initiation: pre 5.4%; post 1.3% (p=0.0075).Conclusion/

Discussion: After our ALPP was initiated there was concern that this increased focus of leak prevention would lead to increased diverting ileostomy creation. However, we have shown the rates of ileostomy creation stayed the same. There was significantly decreased rates of anastomotic leaks and surgical site infections after bundle initiation, even with a significantly larger percentage of colorectal cancer patients in the post ALPP group. Overall, we were able to institute a successful ALPP without increasing the rates of ileostomy creation or complications associated with ileostomies, measured by 30-day readmission and 30-day ED visit rates.Outcomes Pre and Post ALPP Initiation