Annals of Coloproctology

Original Articles

Predisposing factors for high output stoma in patients with a diverting loop ileostomy after colorectal surgeries: Dan Assaf, David Hazzan, Almog Ben-Yaacov, Shachar Laks, Douglas Zippel, Lior Segev; Ann Coloproctol. 2023;39(2):168-174. Published online August 6, 2021; DOI: https://doi.org/10.3393/ac.2021.00241.0034

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Purpose
One of the most common ileostomy-related complications is high output stoma (HOS) which causes significant fluids and electrolytes disturbances. We aimed to analyze the incidence, severity, and risk factors for readmission for HOS.
Methods
We reviewed all patients who underwent loop ileostomy closure in a single institution between 2010 and 2020. Patients that were readmitted for dehydration due to HOS during the time interval between the creation and the closure of the stoma were identified and divided into a study (HOS) group. The remaining patients constructed the control group.
Results
A total of 307 patients were included in this study, out of which, 41 patients were readmitted 73 times (23.7% readmission rate) for the HOS group, and the remaining 266 patients constructed the control group. Multivariate analysis identified; advanced American Society of Anesthesiologists (ASA) physical status (PS) classification, elevated baseline creatinine, and open surgery as risk factors for HOS. Renal function worsened among the entire cohort between the construction of the stoma to its closure (mean creatinine of 0.82 vs. 0.96, P<0.0001).
Conclusion
Loop ileostomy formation is associated with a substantial readmission rate for dehydration as a result of HOS, and increasing the risk for renal impairment during the duration of the diversion. We identified advanced ASA PS classification, open surgery, and elevated baseline creatinine as predictors for HOS.

Citations

Citations to this article as recorded by

High output stoma after surgery for rectal cancer - a risk factor for low anterior resection syndrome?
Xuena Zhang, Qingyu Meng, Jianna Du, Zhongtao Tian, Yinju Li, Bin Yu, Wenbo Niu
BMC Gastroenterology.2025;[Epub] CrossRef
A review of chyme reinfusion: new tech solutions for age old problems
Chen Liu, Sameer Bhat, Ian Bissett, Gregory O'Grady
Journal of the Royal Society of New Zealand.2024; 54(2): 161. CrossRef
Knowledge, attitudes, practices and associated factors regarding high output stoma of ileostomy among colorectal surgical nurses: a multicentre cross-sectional study
Qing Zhang, Jianan Sun, Dongxue Wang, Quan Wang, Haiyan Hu
Supportive Care in Cancer.2024;[Epub] CrossRef
Morphological predictors of water-electrolyte disorders in patients with preventive ileostomy after rectal resection for cancer
A.I. Maksimkin, Z.A. Bagatelia, V.M. Kulushev, E.N. Gordienko, M.S. Lebedko, S.S. Anikina, E.P. Shin
Pirogov Russian Journal of Surgery.2024; (4): 16. CrossRef
The Frequency of Stoma-Related Readmissions After Emergency and Elective Ileostomy Formation: The Leicester Experience
Ting-Wei Wu, Wen Yuan Chung, Hui En Jewel Ng, Ashley Yap, Konstantinos Baronos, Deepak Paul, Christopher P Neal, David Bowrey
Cureus.2024;[Epub] CrossRef
Predictors of High-output Stoma in Diverting Ileostomy for Rectal Cancer Surgery
Hiroaki Uehara, Hitoshi Kameyama, Toshiyuki Yamazaki, Akira Iwaya, Yuya Enoki
Nippon Daicho Komonbyo Gakkai Zasshi.2023; 76(3): 286. CrossRef
Morpho-functional aspects of various parts of the intestine and risk factors associated with the preventive ileostomy (review)
A. I. Maksimkin, Z. A. Bagatelia, E. N. Gordienko, E. B. Emelyanova, D. M. Sakaeva
Koloproktologia.2023; 22(4): 147. CrossRef
Obstructive and secretory complications of diverting ileostomy
Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata
World Journal of Gastroenterology.2022; 28(47): 6732. CrossRef

Malignant disease, Functional outcomes,Colorectal cancer

The Relationship Between High-Output Stomas, Postoperative Ileus, and Readmission After Rectal Cancer Surgery With Diverting Ileostomy: Naa Lee, Soo Young Lee, Chang Hyun Kim, Han Deok Kwak, Jae Kyun Ju, Hyeong Rok Kim; Ann Coloproctol. 2021;37(1):44-50. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.03

4,129 View
168 Download
11 Web of Science
9 Citations

Abstract PDF

Purpose
This study aimed to evaluate the relationship between high-output stomas (HOSs), postoperative ileus (POI), and readmission after rectal cancer surgery with diverting ileostomy.
Methods
We included 302 patients with rectal cancer who underwent restorative resection with diverting ileostomy between January 2011 and December 2015. HOSs were defined as stomas with ≥ 2,000 mL/day output. We analyzed predictive factors for readmission of these patients.
Results
Forty-eight patients (15.9%) had HOSs during the hospital stay, and 41 patients (13.6%) experienced POI. HOSs were strongly associated with POI (45.8% vs. 7.5%, P < 0.001). The all-cause readmission rate was 16.9%, with 19 (6.3%) and 20 (6.6%) experiencing ileus and acute kidney injury, respectively. HOSs (27.1% vs. 15.0%, P = 0.040) and POI (34.1% vs. 14.2%, P = 0.002) were associated with all-cause readmission, and POI was associated with readmission with ileus (17.1% vs. 4.6%, P = 0.007). POI was an independent risk factor for all-cause readmission (adjusted odds ratio [OR], 2.640; 95% confidence interval [CI], 1.162 to 6.001; P = 0.020) and readmission with ileus (adjusted OR = 3.869; 95% CI 1.387 to 10.792; P = 0.010).
Conclusion
POI was associated with readmission, particularly for subsequent ileus, in patients with diverting ileostomy. We should make efforts to reduce POI, such as strong control of HOSs, to prevent readmission.

Citations

Citations to this article as recorded by

High output stoma after surgery for rectal cancer - a risk factor for low anterior resection syndrome?
Xuena Zhang, Qingyu Meng, Jianna Du, Zhongtao Tian, Yinju Li, Bin Yu, Wenbo Niu
BMC Gastroenterology.2025;[Epub] CrossRef
Summary of Best Evidence for the Dietary Management in Patients with High-Output Ileostomy
Ying Wang, Hua Peng, Cui Cui, Qi Zou, Mudi Yang
Journal of Multidisciplinary Healthcare.2025; Volume 18: 877. CrossRef
Maximizing Readmission Reduction in Colon Cancer Patients
Mario Schootman, Chenghui Li, Jun Ying, Sonia T. Orcutt, Jonathan Laryea
Journal of Surgical Research.2024; 295: 587. CrossRef
Analysis of decision-making factors for defunctioning ileostomy after rectal cancer surgery and their impact on perioperative recovery: a retrospective study of 1082 patients
Xiaojiang Yi, Huaguo Yang, Hongming Li, Xiaochuang Feng, Weilin Liao, Jiaxin Lin, Zhifeng Chen, Dechang Diao, Manzhao Ouyang
Surgical Endoscopy.2024; 38(11): 6782. CrossRef
Effect of intracorporeal anastomosis on postoperative ileus after laparoscopic right colectomy
Sangwoo Kim, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek, Young-Gil Son
Annals of Surgical Treatment and Research.2023; 104(3): 156. CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Overall readmissions and readmissions related to dehydration after creation of an ileostomy: a systematic review and meta-analysis
I. Vogel, M. Shinkwin, S. L. van der Storm, J. Torkington, J. A.Cornish, P. J. Tanis, R. Hompes, W. A. Bemelman
Techniques in Coloproctology.2022; 26(5): 333. CrossRef
Postoperative paralytic ileus following debulking surgery in ovarian cancer patients
Eva K. Egger, Freya Merker, Damian J. Ralser, Milka Marinova, Tim O. Vilz, Hanno Matthaei, Tobias Hilbert, Alexander Mustea
Frontiers in Surgery.2022;[Epub] CrossRef
Obstructive and secretory complications of diverting ileostomy
Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata
World Journal of Gastroenterology.2022; 28(47): 6732. CrossRef

Malignant disease

Thirty-Day Readmission After Elective Colorectal Surgery for Colon Cancer: A Single-Center Cohort Study: Jun Seong Chung, Han Deok Kwak, Jae Kyun Ju; Ann Coloproctol. 2020;36(3):186-191. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.11.04

4,240 View
114 Download
9 Web of Science
9 Citations

Abstract PDF

Purpose
There is a concern that enhanced recovery after surgery may affect other proposed quality measures, including the rate of readmission due to early discharge. We examine the 30-day readmission rate, risk factors associated with readmission after elective colorectal surgery for colon cancer, causes of readmission, disease-free survival (DFS), and overall survival (OS) in a single institution.
Methods
We retrospectively investigated 292 patients who underwent elective colorectal surgery for colon cancer between 2010 and 2015. Baseline data including age, sex, body mass index, American Society of Anesthesiologists physical status classification, preoperative comorbidities, previous operation history, TNM stage, surgical approach, operation time, gas passage time, and length of hospital stay were obtained. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with 30-day readmission.
Results
A total of 229 patients who underwent elective colorectal surgery were enrolled. Twenty-four patients were readmitted 30 days after discharge. The most common readmission diagnoses were wound bleeding or surgical site infection. Multivariate analysis indicated that patients who had preoperative hepatic disease were at the highest risk of readmission (odds ratio [OR], 8.98; 95% confidence interval [CI], 7.35–10.61). Survival outcomes were significantly better in the nonreadmitted group (OS, P=0.00; DFS, P=0.04).
Conclusion
This study identified that preoperative comorbidities including hepatic and pulmonary diseases were associated with higher readmission rates after elective colorectal surgery. Moreover, the most common cause of readmission in patients who underwent elective colorectal surgery was wound bleeding or surgical site infection.

Citations

Citations to this article as recorded by

Cost-effectiveness and readmission rates of laparoscopic vs. open surgery for colorectal cancer: evidence from the health insurance review and assessment service dataset in South Korea
Sanghyun An, Sung Eun Hong, Moo Hyun Kim, Ik Yong Kim
Frontiers in Surgery.2025;[Epub] CrossRef
Readmission rates following major colorectal surgery
Aoife Shorten, Matthew G. Davey, William P. Joyce
The Surgeon.2024; 22(2): 116. CrossRef
Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use
Michael M. Vu, Jace J. Franko, Anna Buzadzhi, Beau Prey, Maksim Rusev, Marta Lavery, Laila Rashidi
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(2): 163. CrossRef
Meta-analysis of postoperative incision infection risk factors in colorectal cancer surgery
Li Jia, Huacai Zhao, Jia Liu
Frontiers in Surgery.2024;[Epub] CrossRef
The 30-day readmission rate of patients with an overlap of probable sarcopenia and malnutrition undergoing major oncological surgery
Hadassa Hillary Novaes Pereira Rodrigues, Kathyelli Thaynara Pimenta de Araujo, José Eduardo de Aguilar-Nascimento, Diana Borges Dock-Nascimento
einstein (São Paulo).2024;[Epub] CrossRef
Risk factors for early readmission to hospital in patients with malignancy-related ascites: a retrospective cohort study
Zhenhua Tian, Zhilong Huang, Yaqi Guo, Xiaolin Zhao, Luna Liu, Chunxiao Yu, Qingbo Guan
Frontiers in Oncology.2024;[Epub] CrossRef
A National Cancer Database analysis of the predictors of unplanned 30-day readmission after proctectomy for rectal adenocarcinoma: The CCF RETURN-30 Score
Sameh Hany Emile, Nir Horesh, Michael R. Freund, Zoe Garoufalia, Rachel Gefen, Emanuela Silva-Alvarenga, Steven D. Wexner
Surgery.2023; 173(2): 342. CrossRef
Data analytics and artificial intelligence in predicting length of stay, readmission, and mortality: a population-based study of surgical management of colorectal cancer
Shamsul Masum, Adrian Hopgood, Samuel Stefan, Karen Flashman, Jim Khan
Discover Oncology.2022;[Epub] CrossRef
The 30-day hospital readmission and mortality after surgery in colorectal cancer patients
Mesnad S. Alyabsi, Anwar H. Alqarni, Latifah M. Almutairi, Mohammed A. Algarni, Kanan M. Alshammari, Adel Almutairi, Nahar A. Alselaim
BMC Gastroenterology.2022;[Epub] CrossRef

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