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ViewAttendees 2

Session: Abstract Session: Quality

M205 - ACEI and ARB Use Are Associated with Increased Readmission After Ileostomy Creation

Monday, June 3, 2024
2:09 PM – 2:15 PM ET, USA
Location: Room 314-317

    Abstract Podium Presenter(s)

  • Connie Gan, MD (she/her/hers)

    General Surgery Resident
    Oregon Health and Science University
    Oregon Health and Science University
    Mountain View, CA, United States

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

    • Author(s)

  • SR

    Shahrose Rahman, MD

    General Surgery Resident
    Oregon Health & Science University
    PORTLAND, Oregon, United States

    Disclosure information not submitted.

  • SF

    Shaun Flerchinger, MS

    Data Scientist
    Kaiser Permanente
    Camas, Washington, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • JB

    Jeffrey Barton, MD

    Colon & Rectal Surgeon
    Northwest Permanente
    Clackamas, Oregon, United States

    Disclosure information not submitted.

Purpose/Background: High output ileostomy is a common cause of readmission following new ileostomy creation. The loss of sodium leads to compensatory activation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line therapy for hypertension in the United States. We hypothesized that concurrent use of ACEI or ARB increased the risk of readmission following new ileostomy creation due to the loss of this compensatory mechanism.

Methods/Interventions: Patients that underwent ileostomy creation between 2009 and 2022 at Kaiser Permanente in Portland, OR were included in the study. 30-day hospital readmission was the primary endpoint. Descriptive statistics as well as univariable analysis with chi-square testing was performed, comparing patients with and without ACEI/ARB, type of ileostomy (end, diverting loop ileostomy (DLI), or ileal pouch-anal anastomosis (IPAA)), Charlson Comorbidity Index, additional antihypertensives at discharge (furosemide, hydrochlorothiazide, spironolactone, amlodipine, nifedipine, diltiazem), and readmission diagnosis.

Results/Outcomes: 541 patients were identified with confirmed ileostomy creation in the study period. Of these, 296 (54.7%) were DLI, 219 (40.4%) were end and 26 (4.8%) were IPAA. 226 (41.8%) patients were readmitted within 30 days (Table 1). There was no difference in readmission based on type of ileostomy. Patients using ACEI/ARB were readmitted at a higher rate than those without (82/171, 47.9% vs 144/370, 38.9%, p = 0.05) (Table 1). Similarly, patients readmitted were more likely to be discharged from their index hospitalization with an additional antihypertensive (62/226 27.6% vs 54/315 17.1%, p = 0.004).

Conclusion/Discussion: Inhibition of the RAAS significantly increases the risk for 30-day hospital readmission. In predisposed patient populations such as hypertension, lower threshold may be warranted for patients undergoing ileostomy creation for earlier antimotility agent use or more aggressive rehydration plans.