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.
Discuss the sample size used in this study:
ReplyDeleteThis study looked at 13,628 patients who had undergone ostomy creation. 14.5% of these patients were discharged within 1-2 days post surgery, while the rest were discharged 3-5 days post surgery. Inclusion criteria was that the patient was greater than 18 years old, went home after discharge and were discharged 1-5 after surgery.
Discuss the research question or main problem discussed in the study:
ReplyDeleteThe authors of this study ask the question, does expedited discharge have a higher rate of readmission within 30 days versus non-expedited discharge for those undergoing stoma creation. Looking at 13,628 stoma creation patients, 14.5% of these were discharged 1-2 days post surgery. The rest were discharged 3-5 days post surgery. The authors postulated that there would be a higher readmission rate within 30 days for those with expedited discharge. The main concern is that shorter hospital stays might leave patients less prepared for self-care, leading to complications.
1. How does this research article compare to our practices, policy, and/or procedure.
ReplyDeleteAbdominal stoma surgeries are frequently performed for the management of various medical conditions. Clinical guidelines and recommendations for best practice, technical aspects, and patient assessment and education have been published. However, large-scale research summaries of patients undergoing ostomy surgery are lacking or limited in scope or generalizability. Complications following ostomy surgery are prevalent and negatively influence physical health and health-related quality of life. Factors that may contribute to complications include short length of stay after surgery.
At Saint Joshep Medical Center most surgeries patients only stay 1 or 2 days, health insurances need to be considered. Many times is not enough time for patients to adjust to new lifestyle having a body image. Preoperative patient education and stoma site marking and postoperative ostomy nurse care may help improve patient satisfaction and operative outcomes and avoid readmissions.
2 What are the advantages and disadvantages of implementing the article recommendation on your unit and/or hospital.
Advantages of this article study data and recorded information were in a length 1-5 days within a readmission in less than 30 days. This is a very common practice for most hospitals with this type of procedure, including Saint Joshep Medical Center. The disadvantage is that this article did not mention specific information such as the level of knowledge, this very crucial information. Based on patient’s level of knowledge there is greater degree for proper care on the new ostomy and better outcome. Also, support is not mentioned, since body image is critical for patient’s own health manage.
Describe the method used by the author of the study.
ReplyDeleteThe study was a retrospective cohort analysis using data from the American College of Surgeons NSQIP database for 2019–2020. It included 13,628 adult patients who underwent ostomy construction and were discharged home. Patients were divided into expedited discharge (1–2 days) and non-expedited discharge (3–5 days) groups. The primary outcome was 30-day hospital readmission, and the data were analyzed using multivariable logistic regression and partial effects analysis to account for factors such as procedure type, elective surgery, and preoperative sepsis.
Discuss the research question or main problem discussed in the study?
The study addressed the issue of hospital stay length after ostomy construction, balancing the risks of early discharge against the costs and resource demands of longer hospitalizations. The main research question was whether discharging patients within 1-2 days increases the risk of 30-day readmission compared to a standard 3-5 day stay. Using national data from 13,628 adult patients, the study found that early discharge did not increase readmission rates, suggesting that expedited discharge is safe for carefully selected patients and may help reduce healthcare costs without compromising patient outcomes.
Discuss the research question or main problem discussed in the study ?
ReplyDeleteThe main focus of this research is to look at how often patients have to return to the hospital after getting new ostomies, which are openings created for waste to leave the body after certain medical treatments. The article compares two different hospital stays: one where patients go home quickly, in just 1-2 days, and another where they stay longer, for about 3-5 days. By studying these different lengths of stay, the researchers want to find out if staying in the hospital longer helps patients avoid coming back to the hospital after their surgery. This information could help doctors make better decisions about how long patients should stay in the hospital after getting an ostomy.
What are the limitations of this article ?
This study has some limitations that we need to consider. First, it relies on large national databases, which means that some important clinical details about patients might be missing. Because these databases cover so many cases, they often don’t include information about patients' social factors that affect their health. For example, we can’t see how things like a patient’s job, living situation, or support from family might influence their health. Additionally, the study doesn’t clearly explain why certain surgeries were done or the specific reasons why some patients had to come back to the hospital after their surgery. It’s also possible that some patients had more than one health issue, which could make the results harder to understand.
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ReplyDeleteAdvantages and disadvantages of the proposed recommendations in the article.
ReplyDeleteOne advantage is that it offers valuable insights into real-world clinical practice, as it analyzes data from actual patients undergoing ostomy construction. While the disadvantage can be related to other variables that could influence the outcome such as patients comorbidities or surgeon experience. It also has a short term focus of 30 day post op readmission rates, which may not capture longer-term outcomes or complications.
Limitation of the study.
The study found no significant differences in readmissions between the expedited discharge and non-expedited discharge groups which may be attributed to careful selection of the expedited discharge group. This intentional selection lost the randomization of the sample causing selection bias.
3. 1. How does this research article compare to our practices, policy, and/or procedure.
ReplyDeleteThis retrospective research was based on a review of the national American College of Surgeons National Safety and Quality Improvement Project (NSQIP). According to this research, patients who had ileostomy or colostomy surgeries had the risk of being readmitted to the hospital within 30 days after the surgery. This problem is attributed to complications like dehydration, skin complications, and improper post education. The study had two main variable that were based in the number of days in the hospital, it may varies from 1-5 days. Saint Josephs Hospital practices discharges are planned on the first day patient is admitted. In general, these practices have helped to plan ahead the possible patients’ needs. Again, nurses and case managers played an important role in a successful discharge given proper post-operative education, arrangements with home health nurse, assessed the patient’s or caregiver level of knowledge.
2 What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantages implementing in the article, Saint Joseph’s Medical Center is that many of these recommendations have been part of our practices. For example, some of the post op teaching happened before surgery. This practice has reduced readmissions.
The disadvantage in this article is that it is a retrospective review more than five years old. After the Covid 19 pandemic, healthcare has revolutionized in many ways that many of the old practice are not longer part of our moder health care systems. Another disadvantage that this article has not considered is that it benefits from health insurances. The health insurance has determined the days that a patient needs to stay in the hospital. Moreover, the statistics showed on readmitted to the hospital are in general readmission not specifically to ileostomies and colostomies surgeries or complications.
Alyssa Mendoza
ReplyDeleteDiscuss the sample size used in the study.
The sample size used in the study is composed of 13,628 who underwent ostomy construction between the years 2019 and 2020. A total of 1,980 patients experienced an expedited discharge, within 1 to 2 days of admission. The remaining 11,648 patients had a non-expedited discharge, within 3 to 5 days of admission. It was shown that those who had a simple ostomy creation were more likely to be discharged sooner than those who had a bowel resection and an ostomy creation. In addition, those who had a shorter length of stay had a decreased risk of readmission within 30 days compared to those who had a longer length of stay. Overall, the large sample size allows for a wide array of data collection increasing the study’s generalizability and reliability.
How does this research article compare to our practice, policy and/or procedure?
This research is comparable to our practice at St. Joes. On 7 Northeast we see many patients who undergo ostomy surgery. In general, simple ostomy creations have a shorter length of stay. Typically, a clear liquid diet is initiated sooner with these types of patients. With those who have more complex ostomy surgeries such as those who have a resection with the ostomy creation, the patient is kept nothing by mouth (NPO) for a longer period of time to allow the bowel to rest and heal before introducing liquids or food. On the contrary, it’s not often we see patients readmitted within 30 days of having surgery. Typically we will see the patient in 6-8 weeks when the ostomy is being reversed. On the rare occasion that there are complications post op, patients have a longer length of stay until the complications resolve. I’ve experienced a patient being in the hospital for up to 2 weeks post ostomy creation. Rarely do we see patients readmitted after they are discharged. Being a nurse who works on a med-surg unit that receives many ostomy patients, this article was a very interesting read.
1. Discuss the sample size of the study
ReplyDeleteWith over 13,600 patients, this study has substantial statistical power, which helps make the comparison between expedited and non-expedited groups more reliable. A total of 13, 628 underwent ostomy construction. The expedited discharge group which consisted of 1-2 days was equating about 1,980 patients. White non-expedited patients were approximately 3-5 days consisted of 11,648 patients. The 30 day readmission rates were approximately 13.6% for the expedited group and about 14.2% for the non-expedited group. As we can see the readmission date is similar in a sense that there is no statistically significance in between the two groups.
2. Discuss the research question or main problem discussed in the study.
The main discussion of this article is to compare and see if the expedited discharge of 1-2 days after ostomy construction increases the risk of 30-day readmission compared to extended hospital stay of 3-5 days. The reason why this topic of discussion is important is to identify if shorter hospital stays after ostomy construction jeopardizes a patient's outcome. This is important to discuss because ostomy surgery patients are often at high risk for complications and risk for readmission due to infection, dehydration, or other problems of that sort.
Describe the method used by the author of the study:
ReplyDeleteA retrospective analysis of a prospective database of patients undergoing ostomy construction was utilized using the American College of Surgeons National Safety and Quality Improvement Project data between 2019-2020. It identified patients who underwent ileostomy or colostomy construction. It also includes patients age >18, discharge to home, and post of length of stay 1-5days. They were grouped into expedited discharge (1-2 days) or non-expedited (3-5 days) discharge post operative length of stay.
Describe the research question or main problem discussed in the study:
Expedited discharge after construction of ostomy had a 30-day readmission. Specific comorbidities and procedure type are associated with expedited discharge. This affects readmission rate of 12-27% in 30 days after surgery. It also results in additional $300 million in United States healthcare expenditure. Readmissions can be related to complications that can be preventable with proper training and education. Study showed that there is also lack of instruction on ostomy care at home despite use of Home Health services.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe study suggests that expedited discharge after ostomy surgery can be safe for carefully selected patients. The advantages include shorter hospital stays, lower healthcare costs, quicker return home, and freeing hospital resources without increasing readmission risk. It also supports enhanced recovery protocols, which aim to improve efficiency and patient outcomes. However, disadvantages include the possibility that patients may have less time to learn ostomy care skills in the hospital, which could affect confidence and self-management. It also requires careful patient selection, since those with higher risks or complications may not be good candidates for early discharge.
2. Describe the method used by the author of the study.
The authors conducted a retrospective study using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for 2019–2020. They included adults who had an ostomy created, were discharged home, and had a hospital stay between 1–5 days. Patients were divided into expedited (1–2 days) and non-expedited (3–5 days) discharge groups. The main outcome measured was 30-day hospital readmission. Multivariable logistic regression was used to adjust for demographics, comorbidities, and procedure type. Partial effects analysis was also performed to identify the strongest predictors of expedited discharge. The study found no significant difference in readmission between the two groups.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question was to determine whether patients discharged early (1-2 days) after an ostomy procedure had more readmissions compared to those with a standard discharge (3-5 days). It aimed to compare readmission rates between these two groups. The study evaluated if there was an association between length of stay and readmission rates.
Discuss the sample size used in the study.
The study participants consisted of 13,628 patients. The participants had surgery with ostomy construction with a post-op hospitalization stay between one to five days, were age>18 years old, and discharged home. Participants were classified into two groups, either expedited discharge or non-expedited discharge, based on the hospitalization length.
1. Discuss the research question or main problem discussed in the study
ReplyDeleteThe main problem that is discussed in this study is that after a patient undergoes surgery to create an ostomy hospital readmission rates are some of the greatest amongst gastrointestinal procedures ranging from 12% to 27% within 30 days post-operative. These hospital readmissions result in about an additional $300 million in the US healthcare expenditures. These hospital readmissions are due to stoma complications which are often preventable with training and education. This study evaluates whether or not readmission rates were greater for patients with an expedited discharge (1-2 days) compared to non-expedited discharge (3-5 days) post ostomy construction.
2. Discuss the sample size used in the study
There were 13,628 patients involved in this study. Of these patients, 14.5% (1,980) patients had an expedited discharge. The patients that were included in this study were greater than 18 years old, discharged to home, and had a post-operative hospital stay of 1-5 days. Patients who had a stay greater than 5 days were not included because they were shown to have a complicated inpatient recovery. These patients were divided into 5 subcategories depending on what procedure they had done.
1. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital:
ReplyDeleteAn obvious advantage of expedited discharges for patients with uncomplicated ostomy surgeries for our unit would be less cost to the hospital due to decreased LOS as well as to the patient and their insurance. There is also less chance of developing nosocomial infections that would complicate the recovery process if a patient is discharged home expediently. Developing a protocol for preoperative ostomy education to prepare the patient prior to surgery as the article suggests would additionally strengthen the patient's knowledge and confidence when used in conjunction with early discharge.
The disadvantage of developing a protocol for expedited discharge on our unit is that it would rarely if ever be used. The overwhelming majority of patients on our unit have emergent and complex colon surgeries where ileostomy or ostomy formation is only one aspect of surgery. Often colon resections are also necessary, and fistulas or abscesses add yet another level of complexity. The recovery process takes much longer than 1-2 days, and proper ostomy function can also be greatly delayed. In addition to physiological complications, our hospital is also limited by the fact that ostomy teaching is only available Monday to Friday. If a patient has surgery on a Friday, the first possible day for education by a certified wound nurse would be post-op day 3.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation of the study is that it is only a general retrospective analysis of expedited discharges. The actual details of individual clinical care, education and patient information given are not included, and the differences in these details may or may not affect outcome of the study.
There is also no comparative analysis of enhanced recovery protocols among all the hospitals, and it is possible that facilities with more comprehensive methods and dedicated resources would have more success with a faster discharge and less readmissions. Other limitations not included in the analysis were the exact indication for surgery and the reasons for readmission.