Article: Expedited discharge and risk of readmission after ostomy construction
Year Published: February 2025
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Discuss the research question or main problem discussed in the study?
ReplyDeleteThis study aimed to evaluate the association between hospital readmissions after the surgical placement of a new ostomy, and the initial postoperative length of stay. With new medical advances, many patients discharge from the hospital within 2 days of ostomy placement. This shortened postoperative period could potentially lead to readmissions due to lack of support and education related to the care and maintenance of the patient’s new ostomy. The hypothesis is that patients with expedited discharge would inevitably have an increase in readmission rates during the first 30 day period with their new ostomy. There was an additional hypothesis that certain comorbidities/procedure types would be most associated with these expedited discharges analyzed.
Describe the method used by the author of the study
This study utilized a retrospective review to identify patients who received an ileostomy or colostomy via the 2019-2020 nation American College of Surgeons NAtional Safety and Quality Improvement Project. The study only included patients who were over 18 years of age, discharged directly to home, and have postoperative stays between 1-5 days. This study went through the proper IRB channels utilizing a waiver of informed consent. The variables of interest were patient postoperative lengths of study, and the outcome of interest was postoperative readmission within 30 days. Additional variables noted were patient demographics, comorbidities, and type of ostomy surgery. There was a bivariate analysis comparing the patients who had expeditied discharges vs those with nonexpeditied discharges – this led to a multivariable logistic regression model due to the additional factors previously mentioned.
Discuss the limitations of the article: limited sample size, design flaws and/ or author bias
ReplyDeleteSome limitations the article stated are as follows:
-Study cannot account for ostomy education received by patients
-Patients with non expedited length of stay were not assessed wether they are potentially eligible for expedited stay
-Patients social determinants of health
-Exact reason for surgery
-Unavailability of reasons for readmission.
-The database does not capture emergency department visits or other unplanned healthcare visits that may be necessary for hospital readmission.
What are the advantages and disadvantages of to the proposed recommendations in the article?
-The study emphasizes the importance of taking into account as to which patients may be eligible for an expedited discharge and creation of ostomy care training for these patients.The study recommends that future ostomy education protocols should become more standardized with inpatient/ outpatient resources tailored to expedited discharge pathways. Preventing risk of readmission after ostomy surgery can be done with proposer training and education.
Describe the method used.
ReplyDeleteThis was a retrospective review of data from 2019 to 2020. The information was taken from the ACSNSQIP which is a quality improvement project. The 13,628 patients in this study were all 18 years old or older, discharged home, and had a hospital length of stay between 1 to 5 days. A comparison was made between the expedited discharged patients (1-2 days) versus the non-expedited discharged patients (3-5 days). The study looked at weather the expedited or non-expedited patients would have higher readmission rates.
What are the advantages and disadvantages of the proposed recommendations in the article?
This study found no difference in re-admissions when comparing expedited versus non-expedited patients. An advantages to early discharge would be less risk of a nasocomial infection, possibly better quality of sleep at home, possibly greater comfort at home, and freeing up a hospital bed for another patient to be admitted. Disadvantages to early discharge would be less time for the wound care nurse and bedside nurse to properly educate the patient about ostomy bag emptying and changing, risk of dehydration, and peri-stomal skin complications. At PSJMC the wound ostomy nurses do not usually work on the weekends so the patient would miss out on that educational teaching if they did not get it beforehand and were discharged on a weekend.
Research Question: The researchers noted that hospital readmission rates after ostomy surgery are some of the greatest among all GI procedures ranging from 12-27% in the 30 days after surgery. With the creation of an ostomy patient are expected to quickly learn skills such as changing and emptying their pouch, managing odor, identification of the best supplies for their stoma, diet and hydration management and how to manage potential stoma complications, and while home health is often used after discharge, it is noted that most of this education occurs before hospital discharge. The study authors hypothesized that patients with an expedited discharge after surgery (within 1-2 days) would have a greater rate of readmission within the first 30 days.
ReplyDeleteMethods: A retrospective review of 2019-2020 national American College of Surgeons National Safety and Quality Improvement Project data using Current Procedural Technology codes to identify patient who underwent ileostomy or colostomy construction was performed. The study included patients greater than 18 years of age discharged to home who had a postop length of stay of 1-5 days. The primary independent variable of interest was patient postop length of stay categorized as expedited (1-2 days) compared with non- expedited (3-5 days). The primary outcome of interest was 30 day- post op readmission. CPT codes were divided into 5 subcategories of procedural types: "partial colon resection with ostomy", "total abdominal colectomy with ileostomy", ostomy only creation," "abdominoperineal resection", and "other". The overall association between expedited postop stays and hospital readmission was determined using a multivariable logistic regression model that adjusted for variables that were deemed clinically relevant a priori including patient demographics, comorbidities, and procedures factors. Given significant difference in readmission risk by procedure type, multivariable logistic regression models stratified by procedure category was also utilized.
Discuss the research question or main problem discussed in the study?
ReplyDeleteA retrospective analysis of a prospective database of patients undergoing ostomy construction was performed using the American College of Surgeons National Safety and Quality Improvement Project. date between years 2019 and 2020.Inclusion criteria included age >18years, discharge to homeland post operative length of stay.The primary outcome was a 30 day post operative readmission.Analysis included multivariable logistic regression models and partial effects analysis .Of 16,628 patients included ,14.5% (n=1,980)had an expedited discharge ,Rates of 30-day readmission were13.6% in the expedited group and 14.2% in the non expedited group (P=51),Adjusting for patients and procedure factors, there was no significant difference readmission rates between expedited and non expedited discharge groups(odds ratio,1.08:95% confidence interval 0.94-1.25).In Stratified analysis there was no difference in readmission by discharge timing for any procedure type.The top 3 contributors to having an expedited discharge ,as assessed by partial effects analysis ,were procedure type ,elective surgery and pre operative sepsis.
What are the advantages and disadvantages of to the proposed recommendations in the article?
The Advantages of Expedited Discharge
1.Reduced Hospitalization Costs
for patients expedited discharge can lead to lower overall healthcare costs ,as they spend less time in the hospital while for the healthcare system it decreased length of stay contributes to reduced hospital expenditures and efficient use of resources
2, Improved Hospital flow and capacity
expedited discharge facilitates quicker turnover of hospital beds, leading to increase capacity and reduced congestion in areas like the emergency department and this can improve patient flow and reduce wait times for those needing hospital admission
3.Potentil for improved Patient Outcomes
In some cases ,expedited discharge may be associated with reduced mortality rates ,as seen in meta-analysis of early discharge hospital -at -home discharge programs .Faster transitions to home care can minimize exposure to hospital acquired infections ,especially for vulnerable patients
4.Enhance Patient Satisfaction
Patients and their families generally prefers to return home as soon as possible ,and expedited discharge can lead to increase satisfaction .
While Disadvantages of Expedited Discharge
1.Concerns about increased Readmission rates
while some studies show similar readmission rates with expedited discharge ,concerns remain that patients may not be fully prepared for self career have adequate support at home, potentially leading to readmission
2.Potentials for Unresolved Symptoms and Deterioration
Some patients discharged early may still have unresolved symptoms or experience a decline in their condition after leaving the hospital requiring readmission and this could be due to inadequate pain management's lack of understanding self management,i nstructions ,or insufficient post discharge support
3.Challenges in Discharge Planning and Communication
Effectively coordinating discharge planning and communicating essential information to patients and their families can be challenging ,especially in a fast paced environment like the emergency department
Overall reliance on verbal communication can be a barrier to ensuring patient understanding and compliance with follow up instructiions.