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Journey for patients following ileostomy creation is not straightforward
Dedrick Kok Hong Chan1,2, Jingyu Ng3, Frederick Hong-Xiang Koh1
1Division of Colorectal Surgery, University Surgical Cluster, National University Health System, System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Insights
Ileostomy creation can lead to significant complications, including readmissions and stoma non-reversal. Patients require comprehensive counseling regarding potential risks associated with ileostomy surgery and closure.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Patient Management
Background:
- Ileostomies are created to prevent sepsis from tenuous anastomoses.
- Subsequent issues like readmissions, stoma non-reversal, and closure complications are often underreported.
Purpose of the Study:
- To identify and analyze the complications and outcomes in patients following ileostomy creation.
Main Methods:
- Retrospective analysis of 193 patients who underwent ileostomy creation between 2011 and 2016.
- Statistical analysis to determine risk factors for readmission and non-reversal.
Main Results:
- 13.5% of patients experienced stoma-related complications requiring readmission, most commonly dehydration and acute kidney injury (9.3%).
- 67.4% of ileostomies were reversed; only those from ultra-low anterior resections were significantly associated with reversal.
- 3.6% of reversals led to complications, including anastomotic leaks and sepsis, with one mortality.
Conclusions:
- Nearly half of patients experience adverse outcomes post-ileostomy, including readmissions, non-reversal, and closure complications.
- Informed patient consent detailing these risks is crucial before the initial ileostomy surgery.
Background:
An ileostomy is usually created to avert systemic sepsis in a patient with a tenuous anastomosis. However, what is often not reported are the numerous issues facing these patients subsequently, ranging from readmissions, non-reversal of the stoma, and complications from the closure. This study was performed to identify these issues among patients following creation of an ileostomy.
Methods:
We conducted a retrospective analysis of consecutive patients who had an ileostomy created from January 2011 to December 2016 at two institutions. Statistical analysis was performed to identify risk factors associated with readmissions and ileostomy non-reversal.
Results:
In total, 193 patients had an ileostomy created during the study period. Twenty-six (13.5%) patients developed stoma-related complications requiring readmission. The most common cause of readmission (9.3%) was due to dehydration and acute kidney injury secondary to high stoma output. One hundred thirty (67.4%) patients had their ileostomy reversed. On multivariate analysis, only stomas created during an ultra-low anterior resection were associated with reversal (OR 2.88 [95% CI, 1.24-6.68]; p = 0.014). Among the patients who underwent ileostomy reversal, seven (3.6%) patients developed complications from their ileostomy reversal. Four patients (2.1%) suffered from an anastomotic leak which required repeat surgical intervention with one mortality from the ensuing sepsis.
Conclusion:
Almost half of the patients who had an Ileostomy had an undesirable outcome, including readmissions, non-reversal, and post-operative complications following closure. Patients need to be properly counselled about the risks involved prior to the index operation.
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