Abstract
The aims of this study were to assess the impact of a follow-up nutrition consultation for ostomy patients on the rate of high output stoma (HOS)-related readmissions, as well as on the detection of poor nutritional status and their management, and to determine the associated economic impact. A single-centre ambispective cohort study was conducted in which all adult patients undergoing intestinal resection and stoma creation were recruited. Two nutrition consultations were established for early follow-up after hospital discharge and patients were prospectively included. Additionally, a retrospective search was carried out to include a control group. In both groups, a 12-month follow-up was conducted to record readmissions associated with high output stoma. A multivariate logistic regression was performed. Statistical significance level was established at p < 0.05. 170 patients were recruited, 85 patients in each cohort. Demographic data and clinical characteristics were recorded. A significant difference was observed in HOS-related readmissions, with readmission rates of 28.6% vs 10.3% in the retrospective and prospective cohort, respectively. At the first follow-up consultation, 50.5% of patients presented some degree of protein-calorie malnutrition. A statistically significant improvement in nutritional status was observed in the second evaluation. The intervention carried out resulted in a total saving of €24,175. Early follow-up of patients after discharge resulted in a significant reduction in the rate of HOS-related readmissions and allowed to identify a high percentage of patients with malnutrition. The cost analysis showed the process to be a cost-effective improvement.
Highlights
The aims of this study were to assess the impact of a follow-up nutrition consultation for ostomy patients on the rate of high output stoma (HOS)-related readmissions, as well as on the detection of poor nutritional status and their management, and to determine the associated economic impact
A single-centre ambispective cohort study was conducted in a 350-bed hospital to evaluate the impact of a follow-up nutrition consultation for ostomy patients following hospital discharge on the rate of readmissions associated with HOS
Our findings show that the implementation of a nutrition consultation after hospital discharge is cost-effective as it reduces the rate of HOS-related readmissions and has a lower associated cost
Summary
The aims of this study were to assess the impact of a follow-up nutrition consultation for ostomy patients on the rate of high output stoma (HOS)-related readmissions, as well as on the detection of poor nutritional status and their management, and to determine the associated economic impact. Defunctioning stoma formation following bowel resection is a procedure commonly associated with complications and increased morbidity in patients undergoing colorectal s urgery[1,2] These complications occur in 70–80% of patients[1,3] and include skin problems, necrosis, obstruction, stoma retraction, stoma prolapse, and parastomal herniation, but there are other complications that have been less studied, such as electrolyte disturbances, acute renal failure, and malnutrition associated with the development of high output stoma (HOS)[4,5]. The consequences of a poor nutritional status on health resource utilization and mortality rate highlight the importance of implementing procedures for its accurate diagnosis and the provision of appropriate nutritional support in the standard clinical p ractice[14,15]
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