What are the risk factors for readmission in patients with an ileostomy? / Quais são os fatores de risco para readmissão em pacientes com ileostomia?

PURPOSE: the aim of this study was to identify the risk factors for readmission among patients submitted to colorectal surgery. METHODS: a single-center colorectal quality-assessment database was queried for patients undergoing colorectal procedures with ileostomy during 2009. The sample was divided into readmitted vs. non-readmitted. Readmission was defined as admission within the first 30 days after the index procedure. Groups were compared by pre, intra and postoperative characteristics. A multivariate analysis was performed to identify the risk factors for readmission. RESULTS: the query returned 496 patients, [267 (54%) males, median age 48 years (IQR: 34-60)]. Eighty-three (17%) were readmitted; 296 patients (60%), were operated due to inflammatory bowel disease, 89 (18%) for cancer, 16 (3%) for diverticular disease and 95 (19%) for other diagnosis. The three most common procedures were total proctocolectomy with ileal pouch-anal anastomosis (IPAA) in 103 patients (21%), total colectomy with end ileostomy in 117 (24%) and small bowel resections (including enterocutaneous fistula takedown and J-pouch excision) in 149 (30%). The following variables were significantly more common in readmitted patients: current smoking (24% vs. 14%, p = 0.02), postoperative DVT/PE (10% vs. 4%, p = 0.04), wound infection (20% vs. 10% p = 0.01), sepsis (22% vs. 8% p < 0.001) and organ or space surgical site infection (OrgSSI) (35% vs. 5%, p < 0.001). Postoperative OrgSSI was the only independent factor associated with readmission in a multivariate analysis (p < 0.001). CONCLUSION: colorectal surgeons should be alert for OrgSSI when facing an ileostomy patient readmitted after a colorectal procedure. (AU)

OBJETIVO: o objetivo deste estudo foi identificar os fatores de risco para readmissão em pacientes submetidos à cirurgia colorretal. MÉTODOS: um banco de dados de avaliação da qualidade colorretal em um único centro foi consultado para pacientes submetidos à procedimentos colorretais com ileostomia em 2009. A amostra foi dividida em readmitidos versus não readmitidos. A readmissão foi definida como a admissão dentro dos primeiros 30 dias após o procedimento índice. os grupos foram comparados em relação à características pré, intra e pós-operatórias. A análise multivariada foi realizada para identificar os fatores de risco para readmissão. RESULTADOS: a consulta identificou 496 pacientes, [267 (54%) do sexo masculino, idade média de 48 anos (VIQ: 34 -60)]. oitenta e três (17%) foram readmitidos; 296 pacientes (60%) foram operados por doença inflamatória intestinal, 89 (18%) por câncer, 16 (3%) por doença diverticular e 95 (19%) devido a outro diagnóstico. os três procedimentos mais comuns foram proctocolectomia total com anastomose anal e bolsa ileal (IPAA) em 103 pacientes (21%), colectomia total com ileostomia final em 117 (24%) e ressecções do intestino delgado (incluindo a remoção de fístula enterocutânea e excisão da bolsa em J) em 149 (30%). As seguintes variáveis foram significativamente mais comuns em pacientes readmitidos: tabagismo atual (24 % vs. 14%, p = 0,02), TVP/EP pós-operatório (10% vs. 4 %, p = 0,04), infecção da ferida cirúrgica (20 % vs. 10% p = 0,01), sepse (22% vs. 8%, p < 0,001) e infecção de órgão/espaço do sítio cirúrgico (IOSC) (35 % vs. 5%, p < 0,001). A infecção do IOSC pós-operatório foi o único fator independente associado com a readmissão na análise multivariada (p < 0,001). CONCLUSÃO: os cirurgiões colorretais devem estar alertas para IOSC diante de um paciente com ileostomia readmitido após um procedimento colorretal. (AU)

Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer

PURPOSE: Issues related to body image and a permanent stoma after abdominoperineal resection may decrease quality of life in rectal cancer patients. However, specific problems associated with a low anastomosis may similarly affect quality of life for patients undergoing low anterior resection. The aim of this study was to compare quality of life of low rectal cancer patients after undergoing abdominoperineal resection versus low anterior resection. METHODS: Demographics, tumor and treatment characteristics, and prospectively collected preoperative quality-of-life data for patients undergoing low anterior resection or abdominoperineal resection for low rectal cancer between 1995 and 2009 were compared. Quality of life collected at specific time intervals was compared for the two groups, adjusting for age, body mass index, use of chemoradiation, and 30 days postoperative complications. The short-form-36 questionnaire was used to determine quality of life. RESULTS: The query returned 153 patients (abdominoperineal resection = 68, low anterior resection = 85) with a median follow-up of 24 (3-64) mo. The after abdominoperineal resection group had a higher mean age (63 + 12 vs. 54 + 12, p < 0.001) and more American Society of Anesthesiologists classification 3/4 patients (65 percent vs. 43 percent, p = 0.03) than low anterior resection. Other demographics, tumor stage, use of chemoradiation, overall postoperative complication rates, and quality-of-life follow-up time were not statistically different in both groups. Patients undergoing abdominoperineal resection had a lower baseline short-form-36 mental component score than those undergoing low anterior resection. However, 6 mo after surgery this difference was no longer statistically significant and essentially disappeared at 36 mo after surgery. CONCLUSION: Patients undergoing abdominoperineal resection for low rectal cancer have a similar long-term quality of life as those undergoing low anterior resection. These findings can help clinicians to better counsel patients with low rectal cancer who are being considered for abdominoperineal resection.