Stoma Complications: A Multivariate Analysis

• Published in: The American surgeon Vol. 68; no. 11; pp. 961 - 966
• Main Authors: Duchesne, Juan C., Wang, Yi-Zarn, Weintraub, Sharon L., Boyle, Michael, Hunt, John P.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.11.2002; Southeastern Surgical Congress
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Child, Preschool; Colostomy - adverse effects; Female; Humans; Ileostomy - adverse effects; Infant; Infant, Newborn; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Obesity; Retrospective Studies; Risk Factors; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Human; Dysfunction; Surgery; Risk factor; Digestive diseases; Intestinal disease; Complication; Stoma; Gastrointestinal; Gastric disease
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313480206801106

Construction of a gastrointestinal stoma is a frequently performed surgical procedure. We sought to analyze a large cohort to document the frequency and types of ostomy complications and the risk factors associated with them. The charts of patients undergoing a procedure which resulted in ostomy during a 3-year period were reviewed. Demographics, indication, ostomy type/location, perioperative risk factors, and complications were recorded. Case-control methodology was used to determine crude odds ratios and multiple logistic regression was used to calculate adjusted odds ratios. A P value of less than 0.05 was considered significant. An ostomy was constructed in 204 patients and records were available for 164. Forty-one patients (25.0%) had ostomy complications. Sixteen of these complications (39.0%) occurred within one month of the procedure. Complications included prolapse in nine (22%), necrosis in nine (22%), stenosis in seven (17%), irritation in seven (17%), infection in six (15%), bleeding in two (5%), and retraction in two (5%). Gender, cancer, trauma, diverticulitis, emergency surgery, ileostomy, and ostomy location/type were not associated with a stoma complication. Significant predictors of ostomy malfunction are presented as odds ratios (ORs) with 95 per cent confidence intervals (CIs) and include inflammatory bowel disease (OR = 4.49; 95% CI = 1.16–17.36) and obesity (OR = 2.66; 95% CI = 1.15–6.16). The care of an enterostomal nurse was found to prevent complications (OR = 0.15; 95% CI = 0.03–0.69). We conclude that ostomies have a high risk of complication, which is not related to stoma location or type. Obesity and inflammatory bowel disease predispose to complications. Enterostomal nursing may be instrumental in preventing complications.