Ileostomy Formation Results in Deterioration of Renal Function

There was no significant differences in creatinine or estimated glomerular filtration rate between the readmission group and the no readmission group.

New research suggests ileostomy formation could result in the deuteriation of renal function and higher rates of hospital readmissions.

A team, led by John Panizza, Department of Surgery, Royal Brisbane and Women's Hospital, examined different outcomes for patients undergoing both loop and end ileostomy formation.

Ileostomies

Diverting ileostomies commonly occur after bowel resection to reduce the morbidity of anastomotic leak and pelvic sepsis. A diverting loop ileostomy itself is associated with morbidity and end ileostomies are usually performed alongside subtotal colectomy or proctocolectomy when a distal anastomosis is not created.

Ileostomies work by creating a bypass of the colon, leading to increases in losses of sodium and fluid through the stoma effluent.

Ileostomy formation could be either permanent or intended as temporary to defunction a high-risk pelvic anastomosis to reduce the risk of septic consequences of anastomotic leak. On the downside, this type of operation has a high rate of readmission because of dehydration and is associated with an increase in acute kidney injuries.

This can lead to electrolyte abnormalities and dehydration, there all-cause readmission rates of 26-30%.

The Data

In the single, center, retrospective cohort study, the investigators examined 171 patients who underwent ileostomy formation between 2015-2020. A total of 121 patients had loop ileostomies form and 50 had end ileostomies form.

The patients were split into 2 groups—those who needed readmission within 60 days and individuals who did not. The team also collected data on demographics and renal function and electrolytes at baseline (ileostomy formation) and at elective ileostomy closure, as well as data in ileostomy type, complications, return to theatre, chemotherapy and radiotherapy treatments, and readmissions within 60 days of discharge following ileostomy formation.

The readmission rate of the patients included in the analysis was 38% within 60 days of discharge.

Ileostomy reversal occurred in 45% (n = 77) of patients in a median of 263.5 days post formation and reversal happened in 54.5% (n = 66) of loop ileostomies and 22% (n = 11) of end ileostomies.

In addition, 65 (38%) of patients were readmitted within 60 days of discharge and 1 patient was categorized as ASA 5 and not expected to survive.

The results also show a significant increase in creatinine from baseline blood tests compared to date of elective ileostomy closure in both groups of patients and a significant decrease4 in estimated glomerular filtration rate (eGFR) from baseline blood tests compared to the date of ileostomy closure in both readmission and no readmission arms.

Finally, the team found no significant differences in creatinine or eGFR between the 2 arms at the date of ileostomy closure and baseline serum sodium levels were lower in the readmission group compared to the no readmission arm.

“Ileostomy formation is associated with a deterioration in renal function, which occurs independent of whether the patient requires readmission to hospital,” the authors wrote. “Low serum sodium may be used as a predictor for patients with an increased risk of readmission.”

The study, “Renal dysfunction occurs following ileostomy formation and is independent of readmission,” was published online in ANZ Journal of Surgery.