Post-operative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery – a multi-centre retrospective study

MacDonald, S., Wong, L.-S., Ng, H. J., Hastings, C., Ross, I., Quasim, T. and Moug, S. (2024) Post-operative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery – a multi-centre retrospective study. Colorectal Disease, (doi: 10.1111/codi.16947) (PMID:38499914) (Early Online Publication)

Abstract

Aim: Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma-related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse. There is a paucity of research on specific risk factors within the emergency cohort for development of SRCs. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs within this cohort. Method: Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3-year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs. Results: A total of 455 patients were included (median follow-up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24–5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35–0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92–5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01–8.69), p < 0.001] were risk factors for late SRCs. Conclusion: Stoma-related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting.

• Item Type: Articles
• Additional Information: This research has been partially funded by the Emergency Laparotomy and Laparoscopic Scotland Audit (ELLSA) fund (reference number 2083546).
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Quasim, Professor Tara and Ng, Hwei Jene and Wong, Mr Li Siang and Moug, Ms Susan and MacDonald, Scott

Creator Roles

MacDonald, S.: Conceptualization, Investigation, Writing – original draft, Methodology, Writing – review and editing, Project administration, Data curation
Wong, L. S.: Writing – review and editing, Data curation
Ng, H. J.: Data curation, Writing – review and editing
Quasim, T.: Conceptualization, Writing – review and editing, Visualization, Supervision
Moug, S.: Supervision, Writing – review and editing, Visualization, Conceptualization

• Authors: MacDonald, S., Wong, L.-S., Ng, H. J., Hastings, C., Ross, I., Quasim, T., and Moug, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Colorectal Disease
• Publisher: Wiley
• ISSN: 1462-8910
• ISSN (Online): 1463-1318
• Published Online: 18 March 2024
• Copyright Holders: Copyright © 2024 The Authors
• First Published: First published in Colorectal Disease 2024
• Publisher Policy: Reproduced under a Creative Commons licence