Can we better predict readmission for dehydration following creation of a diverting loop ileostomy: development and validation of a prediction model and web-based risk calculator. 2020

Mohammed Alqahtani, and Richard Garfinkle, and Kaiqiong Zhao, and Carol-Ann Vasilevsky, and Nancy Morin, and Gabriela Ghitulescu, and Julio Faria, and Marylise Boutros
Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada.

Dehydration is the most common morbidity following creation of a diverting loop ileostomy (DLI). We aimed to develop and validate a prediction model and web-based risk calculator for readmission for dehydration following DLI creation. After institutional review board approval, we retrospectively reviewed the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database between 2012 and 2017. Adult patients (> 18 years) who underwent DLI with a resection for colorectal cancer, inflammatory bowel disease, or diverticulitis were identified. Patient demographics, operative and postoperative data were collected. The final prediction model, developed in 60% of the cohort (training set) and which modeled the 30-day cumulative incidence of readmission for dehydration, was selected using highest area under the receiver operating curve (AUC) criterion. Model calibration was assessed with the Hosmer-Lemeshow goodness-of-fit test. The model was then assessed in validation and test sets, using 20% of the cohort for each. Of 25,638 patients in the ACS-NSQIP database who met inclusion criteria, 15,222 patients were randomly selected for the training set. The incidence of readmission for dehydration in this cohort was 2.1%. The final model with the highest AUC retained 12 candidate variables: age, sex, smoking status, diabetes, hypertension, American Society of Anesthesiologists score, type of admission, underlying diagnosis, procedure performed, operative time, index admission length of stay, and major morbidity. The model demonstrated good discrimination (AUC 0.76, 95% CI 0.74-0.79) and the Hosmer-Lemeshow goodness-of-fit test confirmed good calibration (p = 0.50). Five-thousand and seventy-three patients were available for the validation and test sets, respectively, and the model remained strong in both the validation and test sets (AUCs of 0.73 and 0.73, respectively). The prediction model was then converted into a web-based risk calculator. A prediction model and web-based risk calculator for readmission for dehydration after DLI creation was developed and validated, demonstrating good predictive capabilities.

UI MeSH Term Description Entries
D007081 Ileostomy Surgical creation of an external opening into the ILEUM for fecal diversion or drainage. This replacement for the RECTUM is usually created in patients with severe INFLAMMATORY BOWEL DISEASES. Loop (continent) or tube (incontinent) procedures are most often employed. Loop Ileostomy,Tube Ileostomy,Continent Ileostomy,Incontinent Ileostomy,Continent Ileostomies,Ileostomies,Ileostomies, Continent,Ileostomies, Incontinent,Ileostomies, Loop,Ileostomies, Tube,Ileostomy, Continent,Ileostomy, Incontinent,Ileostomy, Loop,Ileostomy, Tube,Incontinent Ileostomies,Loop Ileostomies,Tube Ileostomies
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010359 Patient Readmission Subsequent admissions of a patient to a hospital or other health care institution for treatment. Hospital Readmission,Rehospitalization,Unplanned Hospital Readmissions,Unplanned Readmission,30 Day Readmission,Hospital Readmissions,Readmission, Hospital,Readmissions, Hospital,Thirty Day Readmission,30 Day Readmissions,Hospital Readmission, Unplanned,Hospital Readmissions, Unplanned,Readmission, Patient,Readmission, Thirty Day,Readmission, Unplanned,Rehospitalizations,Thirty Day Readmissions,Unplanned Hospital Readmission,Unplanned Readmissions
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D003681 Dehydration The condition that results from excessive loss of water from a living organism. Water Stress,Stress, Water
D003936 Diagnosis, Computer-Assisted Application of computer programs designed to assist the physician in solving a diagnostic problem. Computer-Assisted Diagnosis,Computer Assisted Diagnosis,Computer-Assisted Diagnoses,Diagnoses, Computer-Assisted,Diagnosis, Computer Assisted
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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