Protocol-based intravenous fluid hydration for newly created ileostomies decreases readmissions secondary to dehydration
Borsuk DJ, Studniarek A, Marecik SJ, Park JJ, Kochar K. Protocol-Based Intravenous Fluid Hydration for Newly Created Ileostomies Decreases Readmissions Secondary to Dehydration. Am Surg. 2021;87(6):897-902. doi:10.1177/0003134820971574
Background: Newly created ileostomies often result in patient readmission due to dehydration secondary to high ostomy output. Implementation of a mandatory home intravenous hydration protocol can avoid this. We aim to evaluate the impact of mandatory home intravenous hydration for patients with newly created ileostomies.
Materials and methods: All patients at a single, tertiary care center who underwent ileostomy creation during a period of sporadic home intravenous hydration (February 2011-December 2013) and mandatory protocol hydration (March 2016-December 2018) were reviewed for incidence of dehydration, readmissions, and emergency department visits.
Results: 241 patients were evaluated. 119 were in the "sporadic" group and 122 were in the "protocol" group. Operative approach differed among both groups, with hydration protocol patients undergoing 15% less open procedures and 4.9% more hand-assisted laparoscopic procedures (P = .0017). Prior to protocol implementation, 23.5% of patients were sent home with intravenous hydration. Length of hospital stay after index ileostomy creation was shorter for "protocol" patients by 3.3 days (P < .0001). 15.1% of "sporadic" patients experienced dehydration as compared to 7.4% of "protocol" patients (P = .0283). Following protocol implementation, the number of patients readmitted due to dehydration increased from 13 to 14 (P = .01).
Discussion: Standardized, mandatory at-home intravenous hydration following ileostomy creation leads to a significant reduction in postoperative incidence of dehydration and dehydration-associated readmissions. This protocol should be followed for all patients with newly created ileostomies, so long as adequate home health nursing support and active surveillance are available.