452 Impact of COVID-19 on the closure of temporary ileostomies following colorectal surgery

Abstract

Abstract Aims Temporary defunctioning ileostomies are created in emergency general surgery and elective colorectal surgery with the aim of reversal in the near future. Ileostomies come with associated morbidity. There is a nationwide delay to closure of ileostomies in the UK for a variety of reasons and Covid-19 has had a further significant impact on surgical waiting lists. We aim to assess the length of delay to reversal of ileostomy and whether there is greater morbidity associated with delayed reversal. Methods All reversal of ileostomy patients referred to the National Waiting Times Centre over a one year period between November 2021 and November 2022 we included. Demographics and details of index surgery were collected, as well as reversal peri-operative details, complications and length of stay. Results Twenty-three patients underwent reversal of ileostomy. Mean age 60.4 years. Mean number of days from index procedure to reversal was 648 days (range 99 – 2136). Reasons for delay were; adjuvant chemotherapy (n=6), waiting list/Covid-19 delays (n=13), patient preference/no reason documented (n=4). There were 7 end ileostomies who underwent laparotomy and 16 loop ileostomies reversed. Mean length of stay was 7.04 days (range 2-19 days). 7 patients had ileus following reversal, 3 had an anastomotic leak requiring return to theatre, 1 returned to theatre for bleeding and 1 developed Clostridium difficile. Conclusion Half of this cohort of patients who were referred as ‘long-waiters’ to the National Waiting Times Hospital developed a complication following reversal of ileostomy. This cohort of patients waited on average 377 days longer than pre-Covid-19 waits (Close-IT).