Short-stay (≤ 1 d) diverting loop ileostomy closure can be selectively implemented without an increase in readmission and complication rates: an ACS-NSQIP analysis

Background: Although short stay (< 1 d) protocols exist for diverting loop ileostomy (DLI) closure, this practice is not widespread. The aim of this study was to identify patient and procedural factors associated with short-stay DLI closure and to study the morbidity of short-stay DLI closure, specifically related to readmission rates. Methods: Adults (aged > 18 yr) who underwent an elective DLI closure between 2012 and 2018 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Short-stay DLI closure was defined as a postoperative stay of 1 day or less. Patients were grouped on the basis of length of stay after DLI closure (< 1 d v. > 1 d). Demographic, clinic, pathologic and operative factors were compared. Multivariable logistic regression was used to identify factors that were independently associated with a short stay, as well as readmission, postoperative major morbidity and mortality. Results: Of the 26 363 patients who underwent DLI closure, 1056 (4.0%) had a short postoperative stay (< 1 d). On crude analysis, short-stay patients were younger, were more likely to be male and white, had procedures with a shorter operative time and had fewer comorbidities. Short-stay patients had lower rates of surgical site infections and major postoperative morbidity. No difference was found in 30-day readmission and mortality rates. On multiple logistic regression, independent predictors of short stay were younger age, shorter operative time and the absence of comorbidities. A short-stay was not associated with readmission or 30-day mortality on multiple regression. Finally, short stay was negatively associated with postoperative major morbidity and surgical site infection. Conclusion: Short-stay (< 1 d) DLI closure can be implemented with younger, healthier patients undergoing shorter operations. A short-stay DLI closure in these patients is safe and is not associated with increased readmission and complication rates.