OBJECTIVES: After ileostomy formation patients can face several problems in the first years. High output stoma (HOS) is one relevant condition likely resulting in electrolyte and acid imbalance due to high water, sodium and often magnesium depletion if not treated properly. It can lead to high costs in the health care system and a high burden for the patient. The aim of this study was to evaluate how laboratory checks are used as a screening tool in Germany.

METHODS: Newly created ileostomy, colostomy and urostomy patients from a claims data set of 2012-2017 were identified retrospectively based on ICPM-GM codes. The database covers 4.8 million insures and is scalable to the whole German population. Individuals with any other ostomy surgery or device prescription one year before stoma-creation were excluded, only continuously insured individuals included and followed-up for 2 years after surgery. Additionally, a PubMed literature search was used to assess issues faced by patients with a HOS condition.

RESULTS: 29% of ileostomy patients in the data set do not get any laboratory check in the first two years after surgery, although in the first year, an average of 6.2 times laboratory checks is received per patient (interval time 60.9 days). A retrospective study by Charité Berlin between 2012-2018 reported 13.9% of ileostomy patients developing a HOS condition. The study also suggested to identify and treat HOS early (Seifarth et.al 2021). Readmission rate due to HOS condition was 23.7% from a study conducted between 2010-2020 (Assaf et.al 2021).

CONCLUSIONS: The study showed that not all patients with an ileostomy get regular checkups, although described as beneficial in the literature. Continuous follow-ups and regular monitoring could be helpful to identify early HOS and reduce readmission rate, resulting in better outcomes.