EP948 - A multimodal patient education program effectively prevents high output ileostomy dehydration

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Purpose/Background: New ileostomy patients must adapt to significant physical and psychological changes. Over time, postoperative hospital stay declined steadily, however high-output dehydration is a continued problem leading to a significant number of patients that need readmission. The aim of this study is to assess the effectiveness of a multimodal protocol, incorporating patient and caregiver education.

Methods/Interventions: All data from patients with a newly created ileostomy during colorectal surgery in a single-center university hospital with a tertiary referral function were prospectively collected over a 6-year period (2018-2023). In June 2020, the multimodal protocol was implemented. The protocol contains in-hospital patient and caregiver education and intensive follow-up during the first week after discharge. A standardized education tool was developed to inform the patient and create awareness of possible complications during hospitalization and at home. Patients were discharged from the hospital with a diary to record ileostomy output, weight, medication and fluid intake. One week after discharge a teleconsultation with the nurse specialist was performed. Primary outcome measure was 90-day readmission rate. Secondary outcomes were length of stay, 30-day readmission rate and postoperative ileus.

Results/Outcomes: Electronic patient record analyses was performed in 907 patients. 423 patients were included in the pre-intervention group, and 454 post-intervention. Four hundred forty-nine of 907 (49.5%) of patients were men and median age was 53 (range 14-88) years. The median BMI was 24 (range 12-82). The most common reason for ileostomy creation was colectomy for inflammatory bowel disease (IBD) in 42% of all patients and colorectal cancer surgery in 35%. All ileostomies were defunctioning and temporary. Overall, 90-day readmission was 22%. The overall 90-day readmission rate was 27% for the pre-intervention group and 17% for the post-intervention group (p < 0.001). The 90-day readmission rate for high-output ileostomy was 16% pre-intervention and 5% post (p < 0.001). The effect of the protocol was more pronounced in the colorectal cancer group. There was no significant difference in length of stay before (10.9±14.5 days) versus after (9±7.2 days) the intervention (p=0.048), showing that the addition of an interventional protocol does not increase the hospital stay.

Conclusion/Discussion: A structured, multicomponent strategy for ileostomy patients including in-hospital patient education (oral and paper-based), education of healthcare professionals, and post discharge evaluation of fluid intake, medication intake, weight and ileostomy output effectively reduces the incidence of high-output dehydration and the need for unscheduled readmission.