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Ostomy Closures in Children: Variations in Perioperative Care Do Not Change the Outcome
Yusuf Hakan Çavuşoğlu1, Ayşe Karaman1, Çağatay Evrim Afşarlar1
1Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Children's Hospital, 06080 Altındağ, Ankara Turkey.
Insights
Surgeons vary in ostomy closure techniques, including antibiotic use and feeding schedules, but patient outcomes remain consistent. Standardizing these procedures can reduce hospital stays and improve surgical site aesthetics in pediatric patients.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
Background:
- Ostomy closure is a common procedure in pediatric surgery.
- Variations in surgical practice may influence patient outcomes.
Purpose of the Study:
- To evaluate ostomy closure applications and outcomes.
- To determine the impact of surgeon-specific practices on postoperative course.
Main Methods:
- Retrospective analysis of 98 pediatric patients undergoing elective ostomy closure.
- Data collected over 8 years at a pediatric surgery training department.
- Complication rates and factors influencing postoperative course were analyzed.
Main Results:
- Superficial surgical site infection (SSI) occurred in 9.4%, organ/cavity infection in 1%, small bowel adhesions in 8.2%, and incisional hernia in 1%.
- Surgeon-specific differences were noted in nasogastric tube withdrawal time, oral feeding initiation, abdominal closure methods, and antibiotic regimens.
- No significant differences in overall postoperative complications were linked to these surgeon-specific variations or preoperative antibiotic regimens.
Conclusions:
- Surgeon variability in ostomy closure practices does not significantly affect patient outcomes.
- Standardization of procedures using practice guidelines can potentially decrease inpatient stays and antibiotic use.
- Standardization may also lead to more aesthetically pleasing incisions.
Abstract:
This study aimed to evaluate ostomy closure applications and outcomes and determine the effect of personal differences among surgeons on patient postoperative course. Ninety-eight patients who underwent elective ostomy (ileostomy and colostomy) closure for 8 years at a pediatric surgery training department were investigated. Postoperative complications included superficial surgical site infection (SSI; 9.4 %), organ/cavity infection (1 %), small bowel adhesions (8.2 %), and incisional hernia (1 %). SSI and postoperative complications were not affected by the preoperative antibiotic regimen used. Operation duration, pre- and postoperative antibiotic use durations, postoperative inpatient period, ostomy type, primary diagnosis, performance of abdominal exploration, SSI, and postoperative complications were not significantly different. However, the time of nasogastric (NG) tube withdrawal, time to oral feeding initiation, abdominal closure method used, and preoperative antibiotic regimen were significantly different among different surgeons. We conclude that while surgeons used different preoperative antibiotic regimens and abdominal closure methods and stipulated different times for NG tube withdrawal and oral feeding initiation, the postoperative course and prognosis were unaffected Thus, the pre- and postoperative inpatient period and antibiotic use duration can be decreased in children by procedure standardization using practice guidelines; the procedures can also be performed with a more aesthetic, acceptable incision.
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