EP377 - The Implementation of a Quality Improvement Pathway for High Ileostomy Output: Early Experience and Outcomes from a Tertiary Referral Center

Purpose/Background: High ileostomy output is a common complication following ileostomy creation, associated with electrolyte disturbances, dehydration, and acute kidney injury, which contributes to prolonged hospital stays and increased readmissions. Although current management typically relies on antidiarrheal agents and fiber supplementation to reduce output, standardized treatment pathways remain limited. This study evaluates the implementation of a quality improvement (QI) algorithm for managing high ileostomy output in the inpatient setting and reports our experience during the first 9 months of its use.

Methods/Interventions: We performed a retrospective review of adults (≥18 years) who underwent ileostomy creation by colorectal surgeons at our tertiary referral center between January 2025 and September 2025. Records were queried using CPT codes, ICD-10 codes, and operative report terms. Patients were included if they had an ileostomy created by our colorectal surgery division. Exclusion criteria included non-ileostomy stomas, stomas created without colorectal surgeon involvement, and short-bowel syndrome. High ileostomy output was defined as greater than 1 liter per day -lower than the commonly used threshold of 1.2 liters-to facilitate earlier initiation of interventions and reduce delays in care. We examined patients who were managed using the high ileostomy output pathway, which involved a standardized, stepwise management algorithm reassessed every 24 hours (Figure 1). Descriptive statistics were used.

Results/Outcomes: Thirty-five patients were included. The median age was 54 years (interquartile range [IQR]; 42-67), and 51% were female (n=18). 69% of patients were white (n=24), and 57% of patients were American Society of Anesthesiologists (ASA) class III (n=20). Median BMI was 25 kg/m². The most common operative approach was open (37%, n=13), and the most frequent procedure was low anterior resection (34%, n=12). High ileostomy output occurred in 51% of cases (n=18), with the QI algorithm applied to 83% of these patients (n=15). Median length of stay was 8 days. The 30-day readmission rate was 26% (n=9), readmission due to acute kidney injury or dehydration occurred in 6% of cases (n=2), the 30-day reoperation rate was 7% (n=1), and no 30-day mortalities were observed.

Conclusion/Discussion: High ileostomy output remains a frequent postoperative challenge, affecting nearly half of patients in this cohort and contributing to substantial readmission rates. Implementation of a structured QI algorithm was feasible and achieved high adherence among eligible patients. These early results highlight the need for standardized inpatient management pathways to reduce complications and improve resource utilization. Further study is warranted to assess the impact on clinical outcomes and cost reduction.

Figure 1
After advancing to a fiber-restricted or regular diet, if ileostomy output exceeds 1 liter per day, we implemented a stepwise management approach every 24 hours until output decreases below 1 liter per day