Predictors of complications from stoma closure in elective colorectal surgery: an assessment from the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP)

• Published in: Techniques in coloproctology Vol. 24; no. 11; pp. 1169 - 1177
• Main Authors: de Paula, T. R., Nemeth, S., Kiran, R. P., Keller, D. S.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Chronic obstructive pulmonary disease; Colorectal Surgery; Elective surgery; Gastroenterology; Humans; Male; Medicine; Medicine & Public Health; Morbidity; Original; Original Article; Ostomy; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative period; Proctology; Quality control; Quality Improvement; Reoperation; Retrospective Studies; Risk Factors; Surgeons; Surgery; United States - epidemiology; United States; Surgical outcomes; Reoperation; Ileostomy; Operative time; National surgical quality improvement program (NSQIP); Colorectal surgery; Patient readmission; Morbidity; Risk factors
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-020-02307-5

Background There is significant morbidity after diverting ileostomy closure, so identifying predictors of complications could be of great benefit. The aim of our study was to evaluate the incidence and risk factors for postoperative morbidity after elective ileostomy closure. Methods The ACS-NSQIP dataset was evaluated for elective ileostomy closures from 1/1/2015 to 12/31/2016. Demographic characteristics, operative, and postoperative outcomes were evaluated. The primary outcome was 30-day major morbidity (Clavien class III and greater). Secondary outcomes were rates and predictors of major morbidity, superficial site infection (SSI), reoperation, and readmission from multivariate logistic regression modeling. Results We retrospectively evaluated 1885 patients. The median operative time was 65 (IQR 50–90) minutes and median length of stay was 3 (IQR 2–5) days. Major morbidity was recorded in 6.7%, including mortality (1.0%), deep/organ space SSI (2.6%), dehiscence (0.8%), reintubation (0.5%), sepsis (1.7%), septic shock (0.8%), and reoperation (3.7%). Readmission was recorded in 9.7% and 6.2% had SSI. Multivariate logistic regression showed male sex (OR 1.584; 95% CI 1.068–2.347; p  = 0.022) and longer operative time (OR 1.004; 95% CI 1.001–1.007; p  = 0.009) were among those variables associated with increased odds of major morbidity. Dyspnea (OR 2.431; 95% CI 1.139–5.094; p  = 0.021) and longer operative time (OR 1.003; 95% CI 1.001–1.007; p  = 0.034) were among the independent risk factors for SSI. Male sex (OR 2.246; 95% CI 1.297–3.892; p  = 0.004, chronic obstructive pulmonary disease (OR 2.959; 95% CI 1.153–7.591; p  = 0.024), and longer operative time (OR 1.005; 95% CI 1.001–1.009; p  = 0.011) were associated with increased odds of reoperation. Chronic obstructive pulmonary disease (OR 2.578; 95% CI 1.338–4.968; p  = 0.005), wound infection (OR 2.680; 95% CI 1.043–6.890; p  = 0.041), and inflammatory bowel disease (OR 2.565; 95% CI 1.203–5.463; p  = 0.015) were associated with increased odds of readmission. Conclusions Elective stoma closure has significant risk of morbidity. Patients with longer operative times were at increased risk for major morbidity, overall SSI, and reoperation. From the analysis, factors specifically associated with major morbidity, overall infectious complications, readmissions, and reoperations were identified. This information can be used to prospectively prepare for these high-risk patients, potentially improving postoperative outcomes.