Factors Associated With Lack of Pre-Operative Stoma Site Marking Before Ostomy Surgery

Preoperative stoma marking is recommended for patients undergoing potential ostomy surgery. Factors influencing marking are unknown. The purpose of this study was to identify factors associated with preoperative stoma site marking.

We analyzed the ACS-NSQIP-Proctectomy database (2016-2022) to identify patients undergoing procedures with planned ostomy creation. Primary outcome was preoperative stoma site marking. Chi-square tests, univariable, and multivariable logistic regression analyses were performed to assess which demographic, clinical, and operative factors were associated with marking.

Of 22,394 patients, 76.8% were marked preoperatively. Marking varied by patient diagnosis-82.0% of the patients with cancer received marking versus 71.3% of those with inflammatory bowel disease versus 62.0% of those with other benign pathologies (P < 0.0001). Non-elective cases had lower marking rates than elective cases-61.1% versus 77.9%, respectively (P < 0.0001). Marking also varied by race and ethnicity. On multivariable analysis, lower odds of marking were observed for inflammatory bowel disease (OR 0.58, 95% CI 0.53-0.63), other benign diagnoses (OR 0.39, 95% CI 0.35-0.43), Hispanic ethnicity (OR 0.65, 95% CI 0.57-0.75), other race (OR 0.69, 95% CI 0.63-0.75), non-elective status (OR 0.45, 95% CI 0.38-0.52), and diverting ostomy (OR 0.91, 95% CI 0.85-0.97). Older age (OR 1.03, 95% CI 1.01-1.06) and later NSQIP year (OR 1.04, 95% CI 1.02-1.05) were associated with higher odds of marking.

Roughly one in four patients who underwent proctectomy with ostomy creation were not marked preoperatively, with lower adherence among younger patients, benign indications, Hispanic ethnicity, non-elective status, and diverting ostomies.