Interventions to reduce dehydration related to defunctioning loop ileostomy after low anterior resection in rectal cancer : a prospective cohort study
(2020) In ANZ Journal of Surgery 90(9). p.1627-1631- Abstract
Background: Defunctioning loop ileostomy (DLI) in low anterior resection (LAR) in rectal cancer patients reduces the morbidity of anastomotic leakages. In our previous study, 30% of patients developed dehydration due to DLI, mostly during the first 6 weeks. This interventional study aimed to reduce these figures by establishing a surveillance programme. Methods: An interventional study of rectal cancer patients undergoing LAR and DLI between 2013 and 2015 was carried out. A historical study group was used as control. Stoma care nurses educated the intervention group about high-output stoma. Blood tests, including creatinine and electrolytes, were taken every second week until 8 weeks post-operatively and an additional control in case of... (More)
Background: Defunctioning loop ileostomy (DLI) in low anterior resection (LAR) in rectal cancer patients reduces the morbidity of anastomotic leakages. In our previous study, 30% of patients developed dehydration due to DLI, mostly during the first 6 weeks. This interventional study aimed to reduce these figures by establishing a surveillance programme. Methods: An interventional study of rectal cancer patients undergoing LAR and DLI between 2013 and 2015 was carried out. A historical study group was used as control. Stoma care nurses educated the intervention group about high-output stoma. Blood tests, including creatinine and electrolytes, were taken every second week until 8 weeks post-operatively and an additional control in case of subjective high-output stoma. Results: Eighty-seven patients underwent LAR and DLI during the study period. Twenty-one (24%) developed dehydration episodes, and nine (43%) of them required readmission. There was no difference compared to the control group, where 29% developed dehydration, and about half (52%) needed readmission (P = 0.62 and P = 0.57, respectively). However, when explicitly examining patients demonstrating symptomatic dehydration, there was a significant difference, that is 10 (11%) versus 27 (29%) (P < 0.005). Overall, the dehydrated group was older and more likely to take diuretics compared to the non-dehydrated group. Conclusion: Our results indicate that reducing dehydration episodes and readmission after DLI is a challenging process. The proposed surveillance was only effective in preventing symptomatic dehydration. Subjects taking diuretics and the elderly are at risk of dehydration and should be followed cautiously.
(Less)
- author
- Munshi, Eihab LU ; Bengtsson, Eva ; Blomberg, Karin ; Syk, Ingvar LU and Buchwald, Pamela LU
- publishing date
- 2020-01-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- defunctioning loop ileostomy, dehydration, high-output stoma, hospitalization, rectal cancer, surveillance
- in
- ANZ Journal of Surgery
- volume
- 90
- issue
- 9
- pages
- 1627 - 1631
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:32840053
- scopus:85089737509
- ISSN
- 1445-1433
- DOI
- 10.1111/ans.16258
- language
- English
- LU publication?
- no
- id
- cc7f4fcb-24dd-4045-a5bf-08ab7362af78
- date added to LUP
- 2020-09-07 14:40:32
- date last changed
- 2024-09-06 03:22:27
@article{cc7f4fcb-24dd-4045-a5bf-08ab7362af78, abstract = {{<p>Background: Defunctioning loop ileostomy (DLI) in low anterior resection (LAR) in rectal cancer patients reduces the morbidity of anastomotic leakages. In our previous study, 30% of patients developed dehydration due to DLI, mostly during the first 6 weeks. This interventional study aimed to reduce these figures by establishing a surveillance programme. Methods: An interventional study of rectal cancer patients undergoing LAR and DLI between 2013 and 2015 was carried out. A historical study group was used as control. Stoma care nurses educated the intervention group about high-output stoma. Blood tests, including creatinine and electrolytes, were taken every second week until 8 weeks post-operatively and an additional control in case of subjective high-output stoma. Results: Eighty-seven patients underwent LAR and DLI during the study period. Twenty-one (24%) developed dehydration episodes, and nine (43%) of them required readmission. There was no difference compared to the control group, where 29% developed dehydration, and about half (52%) needed readmission (P = 0.62 and P = 0.57, respectively). However, when explicitly examining patients demonstrating symptomatic dehydration, there was a significant difference, that is 10 (11%) versus 27 (29%) (P < 0.005). Overall, the dehydrated group was older and more likely to take diuretics compared to the non-dehydrated group. Conclusion: Our results indicate that reducing dehydration episodes and readmission after DLI is a challenging process. The proposed surveillance was only effective in preventing symptomatic dehydration. Subjects taking diuretics and the elderly are at risk of dehydration and should be followed cautiously.</p>}}, author = {{Munshi, Eihab and Bengtsson, Eva and Blomberg, Karin and Syk, Ingvar and Buchwald, Pamela}}, issn = {{1445-1433}}, keywords = {{defunctioning loop ileostomy; dehydration; high-output stoma; hospitalization; rectal cancer; surveillance}}, language = {{eng}}, month = {{01}}, number = {{9}}, pages = {{1627--1631}}, publisher = {{Wiley-Blackwell}}, series = {{ANZ Journal of Surgery}}, title = {{Interventions to reduce dehydration related to defunctioning loop ileostomy after low anterior resection in rectal cancer : a prospective cohort study}}, url = {{http://dx.doi.org/10.1111/ans.16258}}, doi = {{10.1111/ans.16258}}, volume = {{90}}, year = {{2020}}, }