eP117 - Outcomes of Same-Day Discharge Following Stoma Reversal Surgery: A Prospective Comparative Study of Preoperative Bowel Stimulation versus No Stimulation

ePoster Presenter(s)

• 

  Janyssa Charbonneau, MD (she/her/hers)

  General Surgery Resident
  Université Laval
  Quebec, QC, Canada

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

Senior Author(s)

• FL

  François Letarte, MD MHSC

  Colorectal surgeon
  CHU de Quebec
  Québec, Quebec, Canada

  Disclosure information not submitted.

Author(s)

• TP

  Tiffany Paradis, MD

  General Surgery Resident
  McGill University
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• JB

  Jeremi Bedard Ginchereau, MD

  General Surgery Resident
  Department of Colorectal Surgery, Laval university, Quebec, Canada
  Quebec City, Quebec, Canada

  Disclosure information not submitted.
• LL

  Lawrence Lee, MD PhD

  Associate Professor of Surgery
  McGill University Health Centre
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• SD

  Sébastien Drolet, MD FRSCS FACS

  Colorectal surgeon, assistant professor
  CHU de Quebec Universite Laval
  Quebec city, Quebec, Canada

  Disclosure information not submitted.
• 

  Thomas Couture, MD (he/him/his)

  General Surgery Resident
  Laval University
  Laval University
  Quebec, QC, Canada

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• AB

  Alexandre Bouchard, reviewed project

  Colorectal surgeon
  CHU de Québec-Université Laval
  quebec, Quebec, Canada

  Disclosure information not submitted.
• FR

  Francois Rouleau Fournier, MD, MHSc, FRCSC

  Colorectal and general surgeon
  CHUQ - ULAVAL
  Quebec, Quebec, Canada

  Disclosure information not submitted.
• PB

  Philippe Bouchard, MD, FRCSC

  Colorectal surgeon, associate professor
  CHU de Québec-Université Laval
  Québec, Quebec, Canada

  Disclosure information not submitted.
• CT

  Claude Thibault, MD, FRCSC

  Colorectal Surgeon
  Laval University
  Quebec, Quebec, Canada

  Disclosure information not submitted.
• BS

  Barry L. Stein, MDCM, FACS, FABCRS, FRCSC

  Director, Colon and Rectal Surgery
  McGill University
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• PC

  Patrick Charlebois, MD

  Assistant Professor of Surgery
  McGill University
  Montreal, Quebec, Canada

  Disclosure information not submitted.
• 

  A. Sender Sender Liberman, MD

  Colorectal Surgeon
  McGill University Health Centre
  Montreal, Quebec, Canada

  Disclosure information not submitted.

Purpose/Background: Same-day discharge following colorectal surgery has been shown to be safe and effective in select patients. Stoma reversal procedures are associated with a higher risk of postoperative ileus when compared to colectomies. With reported rates up to 32%, ileus is one of the main causes for delayed hospital discharge. Few studies have suggested preoperative bowel stimulation before stoma reversal to potentially reduce postoperative ileus. However, the impact of preoperative bowel stimulation on the feasibility of same-day discharge following stoma reversal is unknown. This study aimed to investigate the role of preoperative bowel stimulation on same-day discharge success rate. A secondary objective was to specifically evaluate the impact of such a preoperative protocol on readmissions and postoperative complications, including ileus.Methods/Interventions: This is a prospective comparative cohort study of adult patients undergoing elective stoma reversal at two referral colorectal centres, from 2020 to 2023. This study encompassed two distinct cohorts: one undergoing preoperative bowel stimulation before stoma reversal (STIM), while the other served as a control group (CC). Patients were eligible for same-day discharge if they had minimal comorbidities, adequate home support and stayed close to a hospital. Patients from the STIM group received preoperative bowel stimulation with daily irrigations of a nutritional formula through their stoma’s efferent limb, 7 days prior to surgery. Patients were discharged on the same day as their surgery if they had adequate pain control, tolerated oral intake and ambulation. Successful same-day-discharge was defined as discharge on postoperative day zero, without any unplanned medical visit within 72 hours from their surgery. Early postoperative follow-up was ensured remotely, either through phone calls by specifically trained nurse practitioners or a dedicated mobile app.Results/Outcomes: A total of 115 patients participated in this study, with 51 in the stimulation group (STIM) and 64 in the control cohort (CC). The STIM cohort was significantly older (mean age 62 (SD9) vs 54 (SD15), p < 0.01), with no difference in sex (63% male vs 52%, p=0.22) or Charlson Comorbidity Index (1.9 (SD1) vs 2 (SD1.7), p=0.57). Operative time was significantly longer in the CC (mean 75 min (SD54) vs 46 min (SD15), p < 0.001) compared to the STIM group. Same-day discharge success rate was similar between the two groups, with 92% (n=47) in the STIM group compared to 82% (n=53) in the CC (p=0.14). 30-day emergency department (ED) visits were not significantly different between the CC (28% (n=18)) and the STIM group (18% (n=9), p=0.11). Readmission rates were significantly higher in the CC (17% (n=11), compared to the STIM cohort (6% (n=3), p=0.05). There was no difference in rates of ileus for the STIM cohort (4% (n=2)) versus the CC (6% (n=4), p=0.57). The Comprehensive Complication Index was also found to be significantly higher in the CC than in the STIM group (18 (SD9) vs 2.4(SD 6), p-value < 0.01).Conclusion/

Discussion: Preoperative bowel stimulation prior to stoma reversal surgery does not seem to impact the rate of successful same-day discharge. However, the use of stimulation was associated with a significant reduction in readmissions and postoperative complications compared to patients without preoperative bowel stimulation. These findings suggest that a preoperative bowel stimulation protocol should be considered as a preparatory measure before elective stoma reversal.Reasons for 30-day Emergency Department Visits