Loop ileostomy closure at an ambulatory surgery facility - A safe and cost-effective alternative to routine hospitalization

Introduction: Temporary loop ileostomies have become widely used in colorectal surgery. Subsequent ileostomy closure has traditionally required hospital admission with observation until return of bowel function. On the basis of clinical observation, the authors hypothesized that loop ileostomy closure may be performed safely without prolonged in-hospital observation. Methods: A protocol for 23-hour observation after loop ileostomy closure was implemented at a single institution and applied to 28 patients at an ambulatory surgery facility. Patient outcomes were reviewed and results compared with a cohort of 30 patients undergoing loop ileostomy closure before introduction of the protocol. Results: The study and control groups were statistically similar in age, gender, diseases, and duration after original operation. Twenty-eight patients underwent loop ileostomy closure, and all were discharged the following day. Two patients were admitted for nausea and vomiting within 48 hours after closure and remained in the hospital for two and four days, respectively. One of these patients was readmitted 12 days after surgery with an abdominal abscess that was drained percutaneously. The mean cost per patient in the study group was $2,665. For the control population, the mean hospital stay was 2.9 days. Return of bowel function was delayed in two patients, resulting in prolonged hospital stays of six and eight days, respectively. Two patients were readmitted after discharge for nausea and vomiting. The mean cost per cohort patient was $3,811. Conclusions: Patients undergoing loop ileostomy closure may be discharged safely after overnight observation without increased complications or hospital readmissions. This practice significantly reduces the use of hospital resources and decreases economic cost without compromising care.