Simple Diverting Colostomy for Sacral Pressure Ulcers: Not So Simple After All

Area of Science:

• Surgical outcomes
• Gastroenterology
• Critical care medicine

Background:

• Diverting colostomy is frequently used for sacral pressure ulcers.
• Evidence on the safety of fecal diversion in this compromised population is limited.
• Malnourished patients with sacral pressure ulcers may experience poor outcomes with diversion.

Purpose of the Study:

• To investigate the safety and outcomes of diverting colostomy in patients with sacral pressure ulcers.
• To identify risk factors for poor outcomes, focusing on nutritional status.

Main Methods:

• Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2012-2018.
• Identification of patients undergoing elective diverting colostomy for sacral pressure ulcers.
• Comparison of 30-day postoperative outcomes, particularly mortality, between patients with and without hypoalbuminemia (defined as albumin < 2.5 g/dL).

Main Results:

• A total of 863 patients were included, with over 40% having preoperative albumin < 2.5 g/dL.
• The 30-day postoperative mortality rate was 6.7%, significantly higher in the hypoalbuminemia group (11.4% vs. 3.5%).
• Preoperative hypoalbuminemia, increased age, preoperative sepsis, and Black race were independently associated with mortality.

Conclusions:

• Diverting colostomy for sacral pressure ulcers is associated with significant postoperative mortality risk.
• Malnourished patients, indicated by hypoalbuminemia, face a substantially higher risk.
• Careful consideration of risks is crucial for surgeons when managing these patients.