SP8.7 Long-term outcomes after stoma siting in emergency surgery – a retrospective multi-centre cohort study

Abstract

Abstract Pre-operative stoma siting has been shown to reduce stoma-related complications in the elective setting and may improve patient quality of life (QoL). However, there is less evidence regarding the effect of stoma siting in patients undergoing Emergency Laparotomy (EmLap), when stoma siting rates may be lower due to time constraints of emergency surgery. This retrospective multi-centre cohort study aimed to compare the long-term outcomes of patients undergoing EmLap who had pre-operative stoma siting with those who didn’t. A retrospective review of a prospectively maintained database of EmLap patients from 3 hospitals across 2 years (Dec ’19-’21) was performed in Dec ’22. Patients with emergency stoma formation per NELA criteria were included and clinical notes were reviewed, including prospectively maintained follow-up from stoma practitioners. Any patients lost to follow-up within a year were excluded. n=381 patients were identified (Mean age-65years, Median follow up-21 months). n=185(48.6%) were marked for a stoma pre-operatively (89.2% by stoma nurse; 10.8% by surgeon). Those not marked pre-operatively had a higher incidence of 30-day overall morbidity (77% v 67%, p=0.0388), stoma-related skin problems (28.1%v18.9%, p=0.0357), ischaemia/necrosis (16v1%, p<0.005) and muco-cutaneous separation (12v3%, p=0.044). There was no significant difference in stoma-related complications between those marked by a stoma nurse compared with those marked by a surgeon (79.4%v66.7%, p=0.1851). Stoma siting in emergency laparotomy is associated with reduced early stoma complications. There are similar outcomes whether the patient is sited by a stoma CNS or a surgeon. Additional education and training should be aimed at surgeons in order to improve frequency of stoma siting in order to improve patient outcomes.