The effect of pre-operative stoma-site marking on peristomal skin health and quality of life

Abstract

Aim: To determine the effect of pre-operative stoma-site marking (siting) on ostomates' peristomal skin health and quality of life (QoL). Methods: The Uses and Attitudes in Ostomy (U&A Ostomy) study was conducted across 148 stoma units in Spain. Specialist stoma care nurses personally assessed each ostomate and collected demographic and clinical data. This included whether the stoma was sited before surgery, the stoma's characteristics, the type of appliance used, any stoma-related complications and frequency of leakage. Participants were also assessed using the Discolouration, Erosion, Tissue overgrowth (DET) Ostomy Skin Tool (0–15), Global Wellbeing scale (0–10) and Stoma-QoL scale (0–100). Findings: The study included 871 ostomates. Of these, 64% were male and 36% were female, the mean age was 64±13 years and the mean BMI was 26.5±11; 57.5% had a colostomy, 28.6% had an ileostomy and 13.9% had a urostomy. A stoma site had been pre-operatively marked and respected in 53.1%, marked but not respected in 2.1% and not marked in 44.8% of the cases. The proportion of new ostomates whose stoma had been sited was seen to have increased in recent years. Stoma siting was associated with a permanent ostomy (p=.0001), absence of effluent leakage (p=.008), absence of complications (p<.0001), lower DET score (p.0007), higher Stoma-QoL score (p=.018) and higher global wellbeing score (p=.0018). Multivariate analysis revealed that pre-operative stoma siting (p<.0001) and type of ostomy (p<.0001) were independent predictors of optimal peristomal skin (DET score 0). The Stoma-QoL score was higher in ostomates with pre-operative stoma siting (58.3±10.2 vs 57±10.3; p=.018). Global wellbeing was also higher in those with pre-operative stoma siting (7.6±1.8 vs 7.19±1.9; p=.0018). Conclusions: In Spain, pre-operative stoma siting is not yet consistently applied in practice, despite the educative efforts made by health professionals. Stoma siting is a first-line opportunity to reduce the occurrence of peristomal skin complications (PSCs), and thus it is associated with fewer PSCs and greater self-perceived QoL. More effort is needed to extend this practice to the majority of patients undergoing stoma-forming surgery.