Enhanced recovery pathways allow for
safe discharge and optimal outcomes within 48 hours
after ileostomy closure. Unfortunately, some patients
undergoing ileostomy closure have prolonged hospital
stays. We have shown previously that the Modified
Frailty Index can help predict patients who will fail early
discharge after laparoscopic colorectal surgery.
OBJECTIVE: The purpose of this study was to use the
Modified Frailty Index to identify patients who were safe
for early discharge after ileostomy closure.
DESIGN: This was a retrospective review.
SETTINGS: The study was conducted at a tertiary referral
center.
PATIENTS: Patients who underwent ileostomy closure
(2006–2015) were stratified into early (≤48 hours) and
late discharge groups.
MAIN OUTCOME MEASURES: The Modified Frailty Index,
morbidity, and readmission rates were measured.
RESULTS: A total of 272 patients undergoing ileostomy
closure were evaluated. Overall length of stay was 3.64
days (±3.23 days), with 114 patients (42%) discharged
within 48 hours. Sex, age, and ASA scores were similar
between early and later discharge groups (p > 0.2).
Univariate logistic regression demonstrated that a
Modified Frailty Index score of 0 was associated with
early discharge (p = 0.03), whereas a Modified Frailty
Index score ≤1 and ≤2 were not. There was no significant
association between the Modified Frailty Index and
complication or readmission rates. Postoperative
complications occurred in 39 patients (14.3%), and 1
patient died secondary to an anastomotic leak. Fifteen
patients (5.5%) were readmitted within 30 days.
Readmission rate within 30 days was 3.2%, with a
Modified Frailty Index score of 0, 6.1% for a Modified
Frailty Index score of <1, and 5.9% for a Modified Frailty
Index score of <2, for which there was not an association
based on univariate logistic regression (Modified Frailty
Index = 0, p = 0.13; <1, p = 0.55; <2, p = 0.53).
LIMITATIONS: The study was limited by nature of being a
retrospective review.
CONCLUSIONS: Patients undergoing ileostomy closure
with a Modified Frailty Index score of 0 are associated
with higher rates of discharge within 48 hours of
ileostomy closure surgery than those with a higher
Modified Frailty Index, without higher readmission
rates. This information can be helpful to better manage
patient and resource use expectations for the duration of
inpatient recovery.