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Readmission common after IPAA surgery, better infection control needed

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ORLANDO, Fla. — Re-hospitalization commonly occurred in patients with ulcerative colitis who underwent ileal pouch anal anastomosis surgery, and may be prevented by reducing surgical site infection rates and postoperative dehydration, according to a poster presentation at AIBD 2017.

One-fifth of patients were readmitted within 30 days of the IPAA surgery, and one-third were readmitted twice, according to Feza Remzi, MD, director of the IBD Center at NYU Langone Health, and professor of surgery at NYU School of Medicine, and colleagues.

To determine 30-day readmission rates and identify predictive factors, Remzi and colleagues reviewed national data on 2,033 patients with ulcerative colitis (mean age, 40 years) who underwent IPAA surgery (41% laparoscopic) between 2012 and 2015. Their average length of stay after surgery was about a week, and the postoperative 30-day morbidity rate was 27.9%.

Overall, 22% of the patients were readmitted within 30 days after surgery (after 2 weeks on average), due to surgical site infection (SSI, 21%), stoma dysfunction (18%), SBO/ileus (15%), infection/sepsis (8%) and GI distress (5%). Further, 39 of these patients were readmitted a second time, and four for a third time within 30 days of surgery.

Multivariate analysis revealed that patients with higher American Society of Anesthesiologists’ classification scores were more likely to be readmitted; a score of 4 carried a six-fold higher risk (OR = 6.1; 95% CI, 1.1-35.6), and scores of 3 (OR = 3; 95% CI, 1.06-8.6) and 2 (OR = 3.1; 95% CI, 1.1-8.7) carried a threefold higher risk.

Younger age was also linked to a higher likelihood of readmission (<40; OR = 1.3; 95% CI, 1.06-1.6) and poor nutritional status (i.e. preoperative albumin levels less than 3.5) carried a threefold higher risk for a second readmission (OR = 3; 95% CI, 1.1-8.2).

Remzi and colleagues concluded that “measures aiming to improve SSI rates and postoperative dehydration should be considered in order to improve outcomes.” – by Adam Leitenberger

Reference:

Aydinli HH, et al. Abstract P-001. Presented at: Advances in IBD; Nov. 9-11, 2017; Orlando, Fla.

Disclosures: Remzi reports no relevant financial disclosures.