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Factors that predict complications after construction of a stoma: a retrospective study
J H Saghir1, F D McKenzie, D M Leckie
1Directorate of Surgery, Monklands Hospital, Airdrie, UK.
Insights
Stoma surgery complications occurred in 68% of patients, with major complications in 26%. Patient age was the key factor predicting major stoma complications, highlighting the need for optimized perioperative care, especially for the elderly.
Area of Science:
- Surgical outcomes research
- Gastrointestinal surgery
- Patient safety
Background:
- Stoma creation is a common surgical procedure with potential for significant morbidity.
- Understanding complication rates and predictive factors is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of stoma surgery complications.
- To identify variables that predict the outcome of stoma surgery.
Main Methods:
- Retrospective study of 126 stoma constructions in 121 patients over one year.
- Data collected from a teaching hospital in Scotland.
- Follow-up conducted until the end of 1999 to assess morbidity and mortality.
Main Results:
- Overall stoma-related morbidity was 68%, with major complications in 26% of patients.
- Two perioperative deaths (2%) and a 7% reoperation rate for major complications.
- Univariate analysis identified age, ASA grade, and surgeon specialty as predictors; multivariate analysis confirmed age as the sole independent predictor (p < 0.001).
Conclusions:
- Optimizing perioperative health, particularly in elderly patients, may reduce stoma surgery morbidity.
- Specialist surgical care is recommended for patients undergoing stomal surgery to improve outcomes.
Objective:
To find out our incidence of complications of stoma surgery and identify variables that predict outcome.
Design:
Retrospective study.
Setting:
Teaching hospital, Scotland.
Subjects:
All 121 patients who had 126 stomas constructed during 1996.
Interventions:
Follow up until the end of 1999.
Main Outcome Measures:
Morbidity and mortality.
Results:
There were 64 men and 57 women, median age 58 years, range 16-83. Forty-three stomas were constructed for malignancy (34%). Forty-two stomas were raised during emergency operations (33%). Colorectal surgeons created 96 stomas (76%). Sixty-one of 92 potentially reversible stomas were closed (66%). Two patients died (2%) perioperatively. Overall stoma-related morbidity was 68% (n = 85). The rate of major stoma-related complications was 26% (n = 33). Nine major complications resulted in a reoperation rate of 7%. On univariate analysis, age, American Society of Anesthesiologists (ASA) grade, and surgeon's speciality were significant predictive variables of major stomal complications (p < or = 0.002, 0.02, and 0.05 respectively). Multivariate analysis showed that the age of the patient was the only factor that independently influenced the outcome of stoma surgery (p < or = 0.001).
Conclusions:
Optimising the perioperative health status of the patients, particularly the elderly, may reduce morbidity. The results also support specialist surgical care of patients undergoing stomal surgery.