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The Dehydration Readmission after Ileostomy Prediction (DRIP) score was used to identify patients at risk of dehydration-related readmission. The aim of this study is to assess the predictive value of the DRIP score for dehydration\u2013electrolyte imbalance (DIE) and hospital readmission in a multicenter Italian cohort. A total of 306 patients with rectal adenocarcinoma who underwent anterior resection with protective ileostomy in 2022 were included. The main outcome measures were the incidence of early and late DIE, hospital readmission due to DIE, and correlations between the DRIP score and other clinical variables. Early DIE occurred in 16.3% of the patients, with 2.6% requiring readmission. Late DIE occurred in 13.7% of the patients, with 3.6% requiring readmission. The DRIP score was significantly correlated with early DIE. A high DRIP score was associated with an increased risk of early and late DIE. Independent predictors of early DIE included high BMI and early postoperative complications. Parastomal infection was the only independent predictor of late readmission. The DRIP score represents a useful tool for identifying patients at risk of early dehydration following ileostomy. While its ability to predict hospital readmission is limited, it provides clinically relevant risk stratification for early DIE and may support targeted postoperative monitoring strategies. Future studies should integrate dynamic patient-specific data to increase the predictive accuracy of the score and guide both inpatient and outpatient care.<\/jats:p>","DOI":"10.1007\/s13304-026-02709-4","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:26:40Z","timestamp":1788787600000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Predicting the risk of dehydration and readmission among rectal cancer patients with ileostomy: a multicenter observational 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