Related Experiment Video
Updated: Jun 30, 2025
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery
Scott MacDonald1, Li-Siang Wong1, Hwei Jene Ng1
1Department of Surgery, Royal Alexandra Hospital, Paisley, UK.
Insights
Stoma-related complications are frequent after emergency intestinal surgery. Preoperative stoma siting is the only modifiable factor to reduce these complications, highlighting a need for improved techniques in emergency settings.
Area of Science:
- Surgery
- Gastroenterology
- Patient Outcomes
Background:
- Emergency intestinal stoma formation affects approximately 4000 UK patients annually.
- Stoma-related complications (SRCs) are common and categorized as early (within 30 days) or late.
- Research on specific risk factors for SRCs in emergency cohorts is limited.
Purpose of the Study:
- To determine the incidence of SRCs following emergency intestinal stoma formation.
- To identify potential risk factors associated with SRCs in this patient group.
Main Methods:
- Prospective data collection from 455 patients across three UK hospitals over three years.
- Utilized the ELLSA database for emergency intestinal stoma cases (colostomy, ileostomy, jejunostomy).
- Multivariate logistic regression analysis to identify risk factors for early and late SRCs, with a minimum one-year follow-up.
Main Results:
- High incidence of SRCs: 54.1% early and 51% late.
- End ileostomy formation was a risk factor for early SRCs (OR 3.51).
- Preoperative stoma siting was protective (OR 0.53), while patient obesity (OR 3.11) and reoperation for complications (OR 4.18) were risk factors for late SRCs.
Conclusions:
- SRCs are a significant issue after emergency intestinal surgery.
- Preoperative stoma siting is the sole modifiable risk factor for reducing SRCs.
- Further research is needed to enhance the frequency and accuracy of preoperative stoma siting in emergency cases.
Aim:
Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma-related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse. There is a paucity of research on specific risk factors within the emergency cohort for development of SRCs. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs within this cohort.
Method:
Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3-year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs.
Results:
A total of 455 patients were included (median follow-up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24-5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35-0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92-5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01-8.69), p < 0.001] were risk factors for late SRCs.
Conclusion:
Stoma-related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting.
Related Concept Videos
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:24Ostomy Care
An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.
There are different types of ostomies, including colostomies, ileostomies, and urostomies:
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:25Endoscopic Procedures II: Colonoscopy
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...