Reducing dehydration-related readmission after ileostomy creation with a risk-stratified post-discharge pathway

Abstract Purpose Dehydration is one of the most frequent and potentially preventable causes of readmission after ileostomy creation. The clinical value of the Dehydration Readmission After Ileostomy Prediction (DRIP) score depends on whether risk stratification can be translated into a structured post-discharge prevention pathway. We evaluated whether implementation of a DRIP-guided, risk-stratified pathway was associated with lower 30- and 90-day readmissions after ileostomy creation. Methods This was a retrospective single-center before-after cohort study including adult patients undergoing loop or end ileostomy creation between January 2015 and December 2021 (pre-implementation) and between January 2023 and January 2025 (post-implementation). The intervention consisted of a DRIP-guided post-discharge pathway including standardized education, monitoring of stoma output and hydration status, early follow-up, and escalation to PICC placement and home intravenous hydration in selected higher-risk patients. The primary outcome was 30-day unplanned dehydration-related readmission. Secondary outcomes included 30- and 90-day all-cause and dehydration-related readmissions. Crude analyses, overlap-weighted propensity score analyses, retrospective DRIP reconstruction in the pre-implementation cohort, and sensitivity analyses were performed. Results A total of 187 patients were included (88 pre-implementation, 99 post-implementation). Among 30-day eligible patients, crude dehydration-related readmission decreased from 12.7% to 2.2%. Overlap-weighted analysis showed a 30-day dehydration-related risk difference of -18.2 percentage points (95% CI -32.6 to -3.8; p = 0.013). Retrospective DRIP reconstruction showed that dehydration-related readmissions were concentrated in higher-risk patients before implementation and were less frequent in similarly high-risk patients after implementation. However, the primary 30-day association was attenuated in a sensitivity analysis restricted to patients discharged within 15 days. Conclusion A DRIP-guided pathway was associated with lower 30-day dehydration-related readmissions after ileostomy creation. These findings support further prospective evaluation of risk-stratified prevention pathways.