Post-operative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery – a multi-centre retrospective study

Abstract

Abstract Aim Approximately 4000 patients undergo emergency intestinal stoma surgery annually in the UK. Stoma-related complications (SRCs) are heterogenous but have previously been sub-categorised into ‘early’ or ‘late-SRCs’. Early-SRCs include: skin excoriation; stoma necrosis; and high-output and generally occur within 30 days post-operatively. Late-SRCs include: para-stomal herniae; retraction; and prolapse. There is a paucity of research investigating risk factors for SRCs within the emergency cohort. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs. Methods Consecutive patients undergoing emergency intestinal stoma surgery (colostomy, ileostomy or jejunostomy) were identified prospectively from 3 acute hospital sites over 3 years from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. Patients were followed up for a minimum of 1 year. A multi-variate logistic regression model was used to identify risk factors for early and late-SRCs. Results n=455 patients were included (Median follow-up-19 months; Age(median) 64 years; Male:Female-0.52;56.7% ileostomies). 54.1% of patients experienced early-SRCs and 51% experienced late-SRCs. n=219 (48.1%) of patients had their stoma sited pre-operatively. Risk factors for early-SRCs included end ileostomy formation (OR 3.51(2.24-5.49), p<0.001), while pre-operative stoma-siting was found to be protective (OR 0.53(0.35-0.83), p=0.005). Patient obesity (OR 3.11(1.92-5.03), p<0.001) and re-operation for elective complications (OR 4.18(2.01-8.69), p<0.001) were risk factors for late-SRCs. Conclusion Stoma-related complications after emergency surgery are common. Pre-operative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving this in the emergency setting.