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  • Title: Standardized postoperative pathway: accelerating recovery after ileostomy closure.
    Author: Joh YG, Lindsetmo RO, Stulberg J, Obias V, Champagne B, Delaney CP.
    Journal: Dis Colon Rectum; 2008 Dec; 51(12):1786-9. PubMed ID: 18575937.
    Abstract:
    PURPOSE: In this study we evaluated the outcome of a standardized enhanced recovery program in patients undergoing ileostomy closure. METHODS: Forty-two patients underwent ileostomy closure by a single surgeon and were managed by a standardized postoperative care pathway. On the first postoperative day, patients received oral analgesia and a soft diet. Discharge was based on standard criteria previously published for laparoscopic colectomy patients. Results were recorded prospectively in an Institutional Review Board-approved database, including demographics, operative time, blood loss, complications, length of stay, and readmission data. RESULTS: The median operative time and blood loss were 60 minutes and 17.5 mL, respectively, and median hospital stay was 2 days. Twenty-nine patients (69 percent) were discharged by postoperative Day 2. The complication rate was 23.8 percent; complications included prolonged postoperative ileus (n = 3), early postoperative small-bowel obstruction (n = 1), mortality not related to ileostomy closure (n = 1), minor bleeding (n = 1), wound infection (n = 1), incisional hernia (n = 1), diarrhea (n = 1), dehydration (n = 1). The 30-day readmission rate was 9.5 percent (n = 4). Two patients had reoperation within 30 days for small-bowel obstruction and a wound infection. CONCLUSIONS: Ileostomy closure patients managed with postoperative care pathways can have a short hospital stay with acceptable morbidity and readmission rates.
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