Ann Surg Treat Res.  2021 Aug;101(2):111-119. 10.4174/astr.2021.101.2.111.

Diverting ileostomy itself may not increase the rate of postoperative readmission related to dehydration after low anterior resection

Affiliations
  • 1Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • 2Biostatistics Collaboration Team, Research Institute and Hospital, National Cancer Center, Goyang, Korea

Abstract

Purpose
This study was performed to evaluate the risk of readmission in the first year after low anterior resection (LAR) for patients with rectal cancer and to identify the contributing factors for readmission related to dehydration specifically.
Methods
This was a retrospective analysis of 570 patients who underwent LAR for rectal cancer at National Cancer Center, Republic of Korea. A diverting loop ileostomy was performed in 357 (62.6%) of these patients. Readmission was defined as an unplanned visit to the emergency room or admission to the ward. The reasons for readmission were reviewed and compared between the ileostomy (n = 357) and no-ileostomy (n = 213) groups. The risk factors for readmission and readmission due to dehydration were analyzed using multivariable logistic and Cox proportional hazard model.
Results
Dehydration was the most common cause of readmission in both groups (ileostomy group, 6.7%, and no-ileostomy group, 4.7%, P = 0.323). On multivariable analysis, risk factors for readmission were an estimated intraoperative blood loss of ≥400 mL (odds ratio [OR], 1.757; 95% confidence interval [CI], 1.058–2.918; P = 0.029), and postoperative chemotherapy (OR, 2.914; 95% CI, 1.824–4.653; P < 0.001). On multivariable analysis, postoperative chemotherapy, and not a diverting loop ileostomy, was an independent risk factor for dehydration-related readmission (OR, 5.102; 95% CI, 1.772–14.688; P = 0.003).
Conclusion
The most common cause of readmission after LAR for rectal cancer was dehydration, as reported previously. Postoperative chemotherapy, not the creation of a diverting ileostomy, was identified as the risk factor associated with readmission related to dehydration.

Keyword

Dehydration; Drug therapy; Ileostomy; Patient readmission

Figure

  • Fig. 1 Cumulative event plot of readmission (A) and readmission related to dehydration (B) after low anterior resection. Overall readmission was observed until 11.8 months after surgery, on average, and readmission related to dehydration specifically until 5.7 months after surgery, on average.

  • Fig. 2 Cumulative event plot according to ileostomy and readmission (A) and readmission related to dehydration (B) after low anterior resection. Cumulative event plot did not identify an association between presence of an ileostomy and readmission generally and readmission related to dehydration specifically.


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