EP965 - Outpatient Diverting Ileostomy Closures: A Comparative Analysis of Hospital and Ambulatory Surgery Center Outcomes

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Purpose/Background: Patients undergoing distal colorectal resections often have diverting ileostomy formation to temporarily divert stool and protect new downstream anastomoses. A loop of terminal ileum is brought to the abdominal wall, allowing for a minimally invasive takedown and closure at the site of the ostomy without a large abdominal incision. Timing of closure is individualized and based on index procedure, co-morbidities, prior complications, and overall clinical status of the patient. Traditionally, this procedure has been performed in the inpatient setting. However, at our institution, there has been a shift toward conducting these procedures outpatient, including at our ambulatory surgery center (ASC). We aim to assess the outcomes of outpatient ileostomy closures as well as compare outpatient procedures performed at our hospital versus the ASC.

Methods/Interventions: A retrospective review of colorectal surgery patients undergoing diverting ileostomy closure at our institution from January 1, 2019 to May 1, 2024 was conducted. Patients were identified using CPT codes. Those who underwent additional procedures at the time of ileostomy closure were excluded from the analysis. Medical records were reviewed to obtain relevant clinical history, operative reports, complications, emergency department (ED) visits within 90 days post-procedure, hospital readmissions, and follow-up clinic visits.

Results/Outcomes: We identified 113 patients who underwent isolated diverting ileostomy closure at our hospital (n=84) and ASC (n=33) from 2019 to 2024. The post-operative admission cohort was comprised of 38 patients with an average length of stay of 2.8 days, while 75 patients were discharged on the day of surgery from the hospital (n=43) and ASC (n=32). The inpatient cohort presented to the emergency department (ED) a mean of 21 days post-procedure with a readmission rate of 5% within 90 days, while the outpatient cohort presented to the ED a mean of 12 days post-procedure with a readmission rate of 17%. A comparison of observed outpatient outcomes at the ASC and the hospital revealed lower ED visit rates (16% vs. 30%), mean ED presentation more days post-operatively (19 vs. 7 days), and lower readmission rates (13% vs. 21%) for procedures performed at the ASC (Table 1). Of all patients readmitted, 3 presented on post operative days 1 to 3, 9 presented days 4 to 14, and 3 presented days 14 to 90.

Conclusion/Discussion: Diverting ileostomy closure is increasingly performed in the outpatient setting at our institution when clinically appropriate. Our evaluation of outpatient outcomes revealed lower ED visit and readmission rates at the ASC with no significant difference in days to ED presentation, supporting the feasibility and safety of performing this procedure in that setting. Additionally, for all patients undergoing outpatient ileostomy closure, we observed ED presentations later than the mean inpatient length of stay, suggesting that admission might not prevent early ED visits or readmissions. These findings support outpatient diverting ileostomy closures as an effective option for patients without increasing readmission rates for early complications. Additionally, results demonstrate favorable outcomes for procedures performed at the ASC, providing opportunity for future cost-benefit analysis of hospital versus ASC procedures to optimize resource utilization and patient experience.