Factors associated with ostomy reversal

Abstract

The natural history of colostomies and ileostomies for colonic disease is not well described. This study aimed to identify factors that have an impact on colostomy and ileostomy reversal among patients with colonic diseases. A retrospective review of patients with ileostomies and colostomies was performed at a university hospital from 1999 to 2005. Demographic, operative, and outcome data were collected. Data were analyzed using analysis of variance (ANOVA), t-test, and descriptive statistics. Mantel-Haenstel chi-square was used to establish association (p<0.05). There were 96 patients (49 women) with an overall mean age of 56 years at the time of ostomy creation. Ostomy reversal was performed for 35 patients after an average interval of 5.6 months (range, 12-432 days). The patients' ages were significantly different between the reversed and nonreversed groups (p=0.01). The mean age was 49.9 years for the reversed group and 60.5 years for the nonreversed group. In a logistic regression model including demographic variables, African Americans were four times less likely to undergo reversal than Caucasians [odds ratio (OR), 0.24; 95% confidence interval (CI), 0.075-0.794]. Loop ileostomies (p=0.05) and sigmoid colostomies (p=0.01) were the only types of ostomies that demonstrated a significant association with reversal. Loop ileostomy was five times more likely to be reversed than sigmoid colostomy (OR, 0.17; 95% CI, 0.049-0.595). Colostomy or ileostomy creation is a basic skill in the armamentarium of the general surgeon for treating complex diseases of the colon. Age, race, and type of ostomy creation are significant predictors for reversal. This data may be useful for consulting patients preoperatively regarding postoperative expectations.