From Formation to Closure: Aggregate Morbidity and Mortality Associated With Defunctioning Loop Ileostomies

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Patient Morbidity

Background:

• Defunctioning loop ileostomies are frequently employed in surgical practice.
• However, these procedures are associated with considerable rates of morbidity and mortality.

Purpose of the Study:

• To comprehensively describe the morbidity and mortality linked to the creation and subsequent closure of defunctioning loop ileostomies.
• To quantify the rates of complications and permanent ostomy.

Main Methods:

• A descriptive study utilizing electronic health records and claims data.
• Inclusion criteria: adult patients undergoing low anterior resection with a concurrent defunctioning loop ileostomy between 2002 and 2014.
• Outcomes: 30-day major complications, acute kidney injury, transfusion, deep space infection, ileostomy reversal rates, and permanent ostomy rates.

Main Results:

• The study cohort included 4658 patients.
• Overall 30-day, 90-day, and 1-year mortality rates were 1.2%, 2.2%, and 5.1%, respectively.
• Major complications occurred in 28.5% of patients, with 13.2% ultimately requiring a permanent ostomy. Post-reversal, major complications dropped to 10.3%.

Conclusions:

• Defunctioning loop ileostomies carry significant morbidity and mortality risks.
• A notable proportion of patients (13.2%) are left with a permanent ostomy after the procedure.
• These findings underscore the importance of careful patient selection and management.