Increased Odds of Perioperative Complications Following Lumbar Diskectomy Among Patients With a Colostomy

Lumbar diskectomy is a commonly performed surgery for which patients may present with conditions predisposing to adverse outcomes, such as the presence of a colostomy. This study aimed to characterize patients undergoing lumbar diskectomy with versus without colostomy and determine whether matched cohorts had differential rates of postoperative complications.

Adult patients undergoing primary lumbar laminotomy/diskectomy were identified from the administrative 2010 to 2022 Q4 PearlDiver M165 database. Two subcohorts were created: (1) patients with a diagnosis code for colostomy without any history of ostomy reversal procedures and (2) patients without colostomy. Those with versus without colostomy were matched and compared for incidence of 90-day postoperative adverse events or secondary surgery within 5 years using multivariable logistic regression, controlling for patient age, sex, and Elixhauser Comorbidity Index (ECI).

Of 365,161 lumbar diskectomy patients, colostomy was present for 355. Following matching, colostomy patients were at higher odds of sepsis (odds ratio [OR] 14.52, P < 0.0001), surgical site infection (OR 6.92, P < 0.0001), wound complications (OR 8.85, P < 0.0001), acute kidney injury (OR 5.26 P < 0.0001), urinary tract infection (OR 4.72, P < 0.0001), pneumonia (OR 3.92, P = 0.0002), as well as 5-year revision lumbar surgeries (OR 2.85, P < 0.0001).

Colostomies are rarely present at the time of lumbar diskectomy, but when present are associated with higher odds of perioperative adverse outcomes (mostly infectious) and 5-year revision lumbar surgeries. These findings may help guide shared decision making and development of risk mitigation strategies.