Early postoperative morbidity and risk stratification in intestinal stoma surgery: A single-center experience

Abstract

BACKGROUND: Intestinal stomas remain an essential aspect of surgical practice despite medical technology advances. This study aimed to evaluate the early postoperative morbidity associated with diversion stomas in both elective and emergency settings.

MATERIALS AND METHODS: A prospective observational study was conducted over 3 years (June 2020 to May 2023) in the Department of General and Minimal Invasive Surgery. All patients aged >18 years undergoing intestinal stoma formation for benign and malignant conditions were included. Early postoperative complications were recorded and analyzed.

RESULTS: A total of 148 patients were included, with 102 (69%) males. The most common procedure was loop ileostomy (105, 71%). Early postoperative complications occurred in 101 (68%) patients, with skin excoriation (53, 36%), mucosal necrosis (31, 21%), and retraction (21, 14%) being the most frequent. Multivariate logistic regression analysis identified emergency surgery (odds ratio [OR]: 2.6, 95% confidence interval [CI]: 1.4-4.9, P = 0.002), low serum albumin (<3 g/dL) (OR: 3.1, 95% CI: 1.5-6.3, P = 0.001), and ileostomy formation (OR: 2.8, 95% CI: 1.3-5.7, P = 0.003) as independent predictors of early postoperative complications. Trainee-led surgeries (OR: 2.4, 95% CI: 1.2-4.8, P = 0.009) and malignancy (OR: 2.2, 95% CI: 1.1-4.5, P = 0.025) were also significantly associated with increased morbidity.

CONCLUSION: Early postoperative complications following stoma formation remain significant. Ileostomies were associated with higher complication rates than colostomies. Patient factors, surgical expertise, and operative conditions significantly influence outcomes. The development of specialized stoma care teams and early involvement of enterostomal therapists may help in early detection and management of complications. Regular audit of outcomes and complications can identify areas for improvement in surgical technique and perioperative care.

Keywords

Cancer / colostomy / complications / gangrene / ileostomy / stoma

References

[1] Pine J , Stevenson L . Ileostomy and colostomy. Surgery (Oxford) 2014; 32: 212- 7.

[2] Ambe PC , Kurz NR , Nitschke C , Odeh SF , Möslein G , Zirngibl H . Intestinal ostomy. Dtsch Arztebl Int 2018; 115: 182- 7.

[3] Malik T , Lee MJ , Harikrishnan AB . The incidence of stoma related morbidity-A systematic review of randomised controlled trials. Ann R Coll Surg Engl 2018; 100: 501- 8.

[4] Bafford AC , Irani JL . Management and complications of stomas. Surg Clin North Am 2013; 93: 145- 66.

[5] Harris DA , Egbeare D , Jones S , Benjamin H , Woodward A , Foster ME . Complications and mortality following stoma formation. Ann R Coll Surg Engl 2005; 87: 427- 31.

[6] Kann BR , Cataldo TC . Early stomal complications. Clin Colon Rectal Surg 2002; 15: 191- 8.

[7] Duchesne JC , Wang Y , Weintraub SL , Boyle M , Hunt JP . Stoma complications: A multivariate analysis. Am Surg 2002; 68: 961- 6; discussion 966.

[8] Robertson I , Leung E , Hughes D , Spiers M , Donnelly L , Mackenzie I , et al. Prospective analysis of stoma-related complications. Colorectal Dis 2005; 7: 279- 85.

[9] Park JJ , Del Pino A , Orsay CP , Nelson RL , Pearl RK , Cintron JR , et al. Stoma complications:The Cook County Hospital experience. Dis Colon Rectum 1999; 42: 1575- 80.

[10] Carlsen E , Bergan AB . Loop ileostomy:Technical aspects and complications. Eur J Surg 1999; 165: 140- 3; discussion 144.

[11] Shabbir J , Britton DC . Stoma complications: A literature overview. Colorectal Dis 2010; 12: 958- 64.

[12] Arumugam PJ , Bevan L , Macdonald L , Watkins AJ , Morgan AR , Beynon J , et al. A prospective audit of stomas——analysis of risk factors and complications and their management. Colorectal Dis 2003; 5: 49- 52.

[13] Londono-Schimmer EE , Leong AP , Phillips RK . Life table analysis of stomal complications following colostomy. Dis Colon Rectum 1994; 37: 916- 20.

[14] Cottam J , Richards K , Hasted A , Blackman A . Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis 2007; 9: 834- 8.

[15] Whitehead A , Cataldo PA . Technical considerations in stoma creation. Clin Colon Rectal Surg 2017; 30: 162- 71.

[16] Nastro P , Knowles CH , McGrath A , Heyman B , Porrett TRC , Lunniss PJ . Complications of intestinal stomas. Br J Surg 2010; 97: 1885- 9.

[17] Salvadalena G . Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: A systematic review. J Wound Ostomy Continence Nurs 2008; 35: 596- 607; quiz 608.

[18] Kwiatt M , Kawata M . Avoidance and management of stomal complications. Clin Colon Rectal Surg 2013; 26: 112- 21.

[19] Formijne Jonkers HA , Draaisma WA , Roskott AM , van Overbeeke AJ , Broeders IAMJ , Consten ECJ . Early complications after stoma formation: A prospective cohort study in 100 patients with 1-year follow-up. Int J Colorectal Dis 2012; 27: 1095- 9.

[20] Krishnamurty DM , Blatnik J , Mutch M . Stoma complications. Clin Colon Rectal Surg 2017; 30: 193- 200.

[21] Mahjoubi B , Moghimi A , Mirzaei R , Bijari A . Evaluation of the end colostomy complications and the risk factors influencing them in Iranian patients. Colorectal Dis 2005; 7: 582- 7.

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International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press