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Interventions to reduce dehydration related to defunctioning loop ileostomy after low anterior resection in rectal cancer : a prospective cohort study

Munshi, Eihab LU ; Bengtsson, Eva ; Blomberg, Karin ; Syk, Ingvar LU and Buchwald, Pamela LU (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.

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author
; ; ; and
publishing date
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
  • scopus:85089737509
  • pmid:32840053
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
2024-02-16 22:01:31
@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 &lt; 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}},
}