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Peristomal Moisture-Associated Skin Damage and Independence in Pouching System Changes in Persons With New Fecal
Midori Nagano1, Yasuko Ogata, Masaomi Ikeda
1Midori Nagano, PhD, RN, CN-WOC, School of Nursing, The Jikei University, Tokyo, Japan. Yasuko Ogata, PhD, MM, RN, PHN, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan. Masaomi Ikeda, PhD, BSc, RTD, Oral Prosthetic Engineering, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan. Kunio Tsukada, PhD, MD, Takaoka Ekinan Clinic, Takaoka, Japan. Keiko Tokunaga, RN, BSN, ETN, Seiei L Sante Co, Nagoya, Japan. Satoru Iida, PhD, MD, Ohta General Hospital, Kohriyama, Japan.
Purpose:
The purpose of this study was to evaluate factors related to peristomal moisture-associated skin damage (MASD) in patients who underwent ostomy surgery because of colorectal cancer, and their independence in pouching system changes. Findings were used to determine pre- and postsurgical care for these patients.
Design:
Retrospective review of medical records.
Subjects And Setting:
The study setting was an 800-bed hospital in metropolitan Tokyo, Japan. The sample comprised 89 patients (median age: 65 years; male vs female: 58 vs 31) who visited a stoma clinic within 8 weeks of ostomy surgery. Fifty-two subjects had ileostomies and 37 had colostomies; data were collected between January 2008 and July 2014.
Methods:
Data were collected from outpatient and inpatient records. Potential relationships between MASD and independence in pouching system changes were evaluated via univariate tests to identify possible associations, followed by logistic regression analysis.
Results:
Patients living with an ileostomy were more likely to experience peristomal MASD than were patients living with a colostomy (odds ratio [OR] = 3.782; 95% confidence interval [CI]: 1.34-10.64; P = .012). Analysis also found that patients with postsurgical chemotherapy were more than 2.5 times more likely to experience peristomal MASD than patients who did not require postoperative chemotherapy (OR = 2.702; 95% CI: 1.02-7.18; P = .046). We also found that patients 65 years or older were significantly more likely to have difficulty in changing their pouching system than were younger patients (OR = 7.193; 95% CI: 2.21-23.41; P = .001), as were those with diabetes mellitus (OR = 11.842; 95% CI: 2.56-54.77; P = .002).
Conclusions:
Patients undergoing ileostomy and those receiving postoperative chemotherapy are more likely to experience peristomal MASD. Older patients (>65 years) and those with diabetes mellitus are less likely to achieve independence. These findings influenced our management of persons undergoing ostomy surgery for management of colorectal cancer in our clinic. We recommend additional research using a larger and more diverse sample to confirm our findings.
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