Closing the loop: Understanding ostomy reversal rates and risks in trauma patients

Area of Science:

• Trauma Surgery
• Surgical Outcomes
• Gastrointestinal Surgery

Background:

• Data on long-term outcomes for diverting ostomies after traumatic colon injuries are limited.
• Predictors for ostomy reversal and complication rates in trauma patients require further investigation.

Purpose of the Study:

• To analyze long-term outcomes, reversal predictors, and complication rates of diverting ostomies in patients with traumatic colon injuries.
• To evaluate the feasibility and impact of concomitant ventral hernia repair during ostomy reversal.

Main Methods:

• Retrospective review of patients with colon injuries undergoing ostomy creation at a level 1 trauma center over 5 years.
• Analysis of demographics, follow-up duration, reversal rates, stoma complications, and factors associated with successful reversal.
• Multivariable logistic regression used to identify predictors of ostomy reversal.

Main Results:

• Of 94 patients receiving ostomies, 64% underwent reversal by 60 months. Early complications included ischemia (3%) and retraction (2%); late complications included parastomal hernia (2%) and prolapse (1%).
• Readmissions (15%) were primarily for dehydration. Concomitant ventral hernia (VH) was present in 27 patients, with 40.7% undergoing repair with reversal. Increasing age and VH predicted lower reversal likelihood, while loop-type ostomies predicted higher likelihood.
• Reversal complications occurred in 17% of patients, including one death.

Conclusions:

• Diverting ostomies for traumatic colon injuries have favorable reversal rates.
• Concomitant ventral hernia repair during ostomy reversal is feasible but associated with lower reversal rates.
• Surgeons must carefully weigh the benefits and risks of diverting ostomies for colon injuries due to overall complication rates.