Stoma Duration Research Articles

UK neonatal stoma practice: a population study

ObjectiveThe optimal time for neonatal stoma closure is unclear and there have been calls for a trial to compare early and late surgery. The feasibility of such a trial will...

The Effect of Spiritual Well-being on the Self-efficacy Level of Individuals with an Intestinal Stoma.

To investigate the spiritual well-being and self-efficacy levels in patients with intestinal stomas. For this descriptive study, researchers conducted face-to-face interviews with 51 participants. Data were analyzed using a descriptive characteristics questionnaire, the Stoma Self-efficacy Scale (SSES), and the Three-Factor Spiritual Well-being Scale (TF-SWBS). Participants had a mean SSES score of 56.98 ± 21.24. Education level and stoma type affected the SSES scores. Income level affected TF-SWBS scores. There was no correlation between SSES and TF-SWBS total scores. There was a positive correlation between TF-SWBS scores and stoma duration and age. Nurses should provide trainings to develop self-efficacy among and enhance psychosocial and spiritual support for patients with a stoma.

Stoma Self-care: Knowledge and Practices among Ostomates with Intestinal Stoma

The objectives of the study were: (1) to assess the knowledge of ostomates regarding self-care of stoma, (2) to assess the practices of ostomates during self-care of stoma, and (3) to find out the association of knowledge of ostomates regarding self-care of stoma with selected clinical and sociodemographic variables.The study was conducted in stoma clinic of selected tertiary care hospitals, New Delhi, India using cross-sectional and descriptive study design. Two hundred and fifty subjects with intestinal stoma were recruited in the study using total enumerative sampling technique. Data were collected using self-structured questionnaire that was developed utilizing an adapted version of the “home management guidelines for stoma care.” Slightly more than half of the subjects (50.4%) had good knowledge regarding self-stoma care. However, 44.8% of subjects had average knowledge regarding stoma self-care, and only 4.8% had poor knowledge regarding self-stoma care. Duration of stoma, status of stoma (whether temporary or permanent), training received regarding stoma care, and subjects linked with stoma group were statistically significant (p < 0.05) in predicting knowledge regarding stoma self-care. The study emphasizes on educational needs of ostomates and recommends developing strategies to meet these needs.

ASSESSMENT OF NUTRITIONAL STATUS, SELF-ESTEEM, AND QUALITY OF LIFE IN STOMATIZED PATIENTS

The prospective study of Nishtar Hospital Multan from January 2022 to January 2023 to assess the impact of intestinal stomas on patients' quality of life and nutritional status. Patients of both genders, aged > 18 years, having intestinal stoma, were included. A total of 100 participants were included in the study. A questionnaire including demographic details, information regarding the stoma, and the Rosenberg Self-Esteem Scale/UNIFESP-EPM quality of Life Scale was used to collect data.59 respondents had low self-esteem (<15), having a mean Score of 0.56; 11 had normal self-esteem with a mean value of 0.64, and 30 had high self-esteem (>25), having a mean of 0.62. A significant association and positive correlation existed between self-esteem and nutritional status (P= 0.04). Linear regression analysis showed a significant association between nutritional status and duration of stoma (P=0.011), type of stoma (P=0.05), monthly income (P=0.01), and number of meals/day (P=0.002). Moreover, there was a significant difference between median QoL – SeSi scores of urostomy patients (Mdn=18.5) compared to those who had a stoma (Mdn=16.5) or an inflamed appendix (16.0) (P= 0.04). Analysis of QoL-FF Score (relation with friends and family) showed urostomy patients (Mdn = 34.5) had substantially higher ratings than colostomy patients (median = 33.5, p = 0.02), and ileostomy patients (Mdn = 32.0, p = 0.025). There was no discernible difference between colostomy as well as ileostomy ratings. It was concluded that stoma patients' quality of life, self-esteem, and nutritional status are interconnected.

Low anterior resection syndrome.

Low anterior resection syndrome (LARS) is the distressful defecatory functional problem after sphincter-saving surgery for rectal cancer. Although the symptoms of fecal urgency, frequency, and incontinence may develop in most of the patients after surgery, there is no definitive treatments for LARS. Multifactorial etiologies and various risk factors have been identified, but the reduction of storage capacity in the rectum is one of the main reasons for LARS. Anal sphincter muscle or nerve damage during rectoanal resection or anastomosis construction, and intersphincteric resection for low-lying tumors or hand-sewing anastomosis, are the absolute risk factors for LARS. Preoperative radiotherapy, postoperative complications, such as anastomosis leakage, or longer duration of stoma, are also risk factors. The severity of LARS can be confirmed using the LARS score questionnaire. The questionnaire has been translated to numerous language versions including Korean and have been validated. Diverse empirical treatments, such as loperamide, fiber, probiotics, or enema, have been tried, but the safety and efficacy have not been verified yet. The 5-Hydroxytryptamine (5-HT) receptor antagonist, ramosetron, used for diarrhea-dominant irritable bowel syndrome, is one potential drug for relieving the symptoms of major LARS. A randomized-controlled trial suggested the use of ramosetron could be safe and efficacious for patients who have major LARS after sphincter-saving rectal cancer surgery. Novel techniques or drugs for relieving the symptoms of LARS should be developed more and further studies are necessary.

Ostomy-Related Quality of Life in Puerto Ricans Living With Inflammatory Bowel Disease: A Prospective Cohort Study.

The aim of this study was to determine ostomy-related quality of life (QOL) in Hispanic Puerto Ricans living with an enteral stoma and inflammatory bowel disease (IBD). We analyzed possible associations between QOL and sex, diagnosis, and type and duration of stoma. Prospective cohort study. The sample comprised 102 adults living with IBD and an ostomy; 60 of 101 (59.4%) were males, 44 of 102 (43.1%) had Crohn's disease, and 60 of 102 (58.9%) had an ileostomy. Participants were receiving care at the Center for IBD of the University of Puerto Rico in San Juan, Puerto Rico, between January 2012 and December 2014. One-hundred two adults Puerto Ricans with IBD completed the Stoma Quality of Life (Stoma-QOL) questionnaire. Data were analyzed using frequency distributions for categorical variables and summary statistics for continuous variables. Independent-group t test and one-way analysis of variance, with the post hoc Tukey test, were used to determine group differences for the variables of age, sex, civil status, time living with an ostomy, type of ostomy, and IBD diagnosis. Results were analyzed according to the number of responses to each variable; the denominator varied for some variables. Having an ostomy for more than 40 months was significantly associated with a higher QOL score (59.0 vs 50.7; P = .05). Males had significantly higher scores than females (59.94 vs 50.23; P = .0019). Age, IBD diagnosis, and type of ostomy were not associated with the Stoma-QOL scores. The achievement (over 40 months) to attain improved ostomy-related QOL suggests that early training in the care of the ostomy and advanced planning when leaving home may enhance ostomy-related QOL. Lower QOL in women may represent an opportunity for a sex-specific educational intervention.

The effect of self-efficacy levels of patients with intestinal stoma on stoma adaptation

This study was conducted to examine the effect of self-efficacy levels on stoma adaptation in patients with intestinal stoma. The study was planned as descriptive and analytical and was carried out in the university adult hospital general surgery stoma and wound care unit. Sixty-two patients with intestinal stoma who met the admission criteria were included in the study. Ethics committee approval, institutional permission and patient consent were obtained for the study. Data were collected from June to September 2021 using the Descriptive Feature Information Form, the Self Efficacy Scale for Individuals with Ostomy, and the Ostomy Adjustment Inventory (OAI-23). Data were analyzed by number, percentage, mean, standard deviation,Mann Whitney U, t test, ANOVA, Pearson's correlation, and linear regression analysis tests. The mean age of the patients with intestinal stoma who participated in our study was 53.12 ± 12.30 years; 71% of them were women, 83.9% were married, and 32.2% were primary and secondary school graduates. The duration of stoma was 8.45 ± 4.69 months, 80.6% of them were opened due to cancer, and 54.8% of them had temporary colostomy. There was a weak and significant correlation between the duration of stoma of the patients and their self-efficacy and stoma adaptation, and as their self-efficacy levels increased, their stoma adaptation increased (p < .05). Self-efficacy is one of the important factors affecting patients' adaptation with the stoma. For this reason, it is recommended to plan trainings to support the self-efficacy levels of patients and to conduct interventional studies in this direction.

Costs Related to Diverting Ileostomy After Rectal Cancer Surgery: A Population-Based Healthcare Cost Analysis Based on Nationwide Registers.

Low anterior resection for rectal cancer often includes a diverting loop-ileostomy to avoid the severe consequences of anastomotic leakage. Reversal of the stoma is often delayed, which can incur health-care costs on different levels. The aim is to, on population basis, determine stoma-related costs, and to investigate habitual and socioeconomic factors associated to the level of cost. Multi-register design with data from the Swedish Rectal Cancer Registry, the National Prescribed Drug Register, Statistics Sweden and cost-administrative data from the National Board of Health and Welfare. Data was gathered for 3564 patients with rectal cancer surgery 2007 to 2013, for 3 years following the surgery. Factors influencing the cost of inpatient care and stoma-related consumables were assessed with linear regression analyses. All monthly costs were higher for females (consumables P < .001 and in-patient care P = .031). Post-secondary education (P = .003) and younger age (P = .020) was associated with a higher cost for consumables while suffering a surgical complication was associated with increased cost for inpatient care (P < .001). Patients who had their stoma longer had lower monthly costs (consumables P < .001 and in-patient care P < .001). Female gender, longer duration of stoma, young age, and higher education are associated with higher costs for the care of a diverting stoma after rectal cancer surgery. This study does not allow for analyses of causality but the results together with deepened analyses of underlying reasons form a proper basis for decisions in health care planning and allocation of resources. These findings may have implications on the debate of equal care for all.

Sleep Quality and Factors Affecting Sleep in Individuals With an Intestinal Ostomy: A Descriptive Cross-Sectional Study

BACKGROUND: Multiple factors affect the sleep quality of individuals with intestinal stomas. PURPOSE: This study sought to determine sleep quality and factors affecting sleep in individuals with intestinal ostomies. METHODS: A descriptive cross-sectional design was used. This study followed 68 individuals with intestinal stomas at the stoma therapy unit of a university hospital. A form was used to gather information about patient demographic and stoma-related data (age, sex, work status, stoma duration, cause and type of stoma, stoma care provider, sleep status during the day, daily coffee consumption, and stoma-related factors affecting sleep), and the Pittsburgh Sleep Quality Index was used to score patient sleep patterns. Descriptive statistics, t-test, chi-square test, Fisher’s exact test, and logistic regression analysis were used for statistical analysis. RESULTS: The patients’ mean age was 53.7 ± 13.8 years; 51.5% were male, and 66.2% were married. Of the 68 patients, 41.2% had a diagnosis of rectal cancer, and 55.9% had ileostomies. Mean stoma duration was 24.1 ± 5.8 months, and 57.4% of participants performed their own stoma care. On a scale of 0 to 21, the participants’ mean sleep score was 9.08 ± 5.03, and 66.2% of patients were found to have poor sleep quality. High sleep quality was significantly positively associated with colostomy (odds ratio, 1.78; 95% confidence interval [CI], 1.18–2.69; P = .006) and self-performed stoma care (odds ratio, 1.54; 95% confidence interval, 1.03–2.30; P = .036). CONCLUSION: The results of the current study can provide reference data for future studies and highlight the importance of assessing sleep quality in persons with intestinal stomas.

102 Quality of Life After Intestinal Stoma: A Cross Sectional Study Among a Sample of Sudanese Patients

Abstract Aim The effects of stoma surgery are multiple, and patient’s quality of life is affected in many ways. Stoma is increasingly used as surgical technique in Sudan, however; studies assessing its effects are lacking. Method a descriptive cross-sectional study was conducted in 3 hospitals in Khartoum state. Patients were interviewed using structure questionnaire Results 65.9% (27) of the patients were males, the mean age was 44.36 (±14.3) and 36.6% had primary school education. 43.9% were unemployed. Mean duration of stoma was 10.67(±10.5) months, and it was temporal in 61% (25). Colorectal cancer was the most indication for the stoma. 70.7% (29) were married, 34.3% (12) reported change in their work after surgery and 68% (17) said it was due to the stoma surgery. Of those who were sexually active, 45.2% (14) didn’t resume their sexual life after it, and most of those who returned report it not to be satisfactory. The entire social and most of the religious practices were found to be statistically different before and after surgery. The mean score for the psychological quality of life was 58.47 (±13.32) out of 80. Conclusions Although stoma patients generally have poor quality of life, they struggle in sexual, social, work, and religious aspects. Patients have good psychological quality of life. Efforts to improve the quality of life and incorporation into the community are needed

The impact of prolonged delay to loop ileostomy closure on postoperative morbidity and hospital stay: A retrospective cohort study.

AimThere is increasing evidence that delayed loop ileostomy closure is associated with an increase in postoperative morbidity. In the context of a publicly funded health service with constrained theatre access, we review the impact of delay in loop ileostomy closure.MethodA retrospective cohort study of patients undergoing loop ileostomy closure at the Dunedin Public Hospital between 2000–2017 was performed. Cases and complications were identified from the prospectively maintained Otago Clinical Audit database. Patient demographics, ASA score, indications for ileostomy, reasons for delay in closure, length of stay (LOS) after ileostomy closure and complications were collected. LOS and overall complication rate were assessed using univariable and multivariable analyses.ResultsA total of 292 patients were included in the study, of whom 74 (25.3%) were waiting for longer than 12 months for ileostomy closure. The overall complication rate was 21.5%. This was 8% up to 90 days, 20% between 90–360 days, 28% between 360–720 days and 54% after 720 days. Delay was associated with an increased risk of any complication (RR 1.06 for every 30 days with stoma, p < 0.001), including Ileus (OR [95% CI] 1.06 [1.00–1.11], p = 0.024). Overall mean LOS was 5.9 days (range 1–63), being 4.6 days up to 180 days, 5.6 between 180–720 days and 8.7 after 720 days. LOS significantly increased with increasing stoma duration (p = 0.04).ConclusionIncreasing time with loop ileostomy is detrimental for patients, being associated with an increase in complication rates, and is detrimental for hospitals due to increased length of stay. Resources should be allocated for timely closure of loop ileostomies.

Pelvic floor peritoneum reconstruction is a protective factor for defecation dysfunction after laparoscopic anterior resection in patients with middle and low rectal cancer.

The pelvic cavity is a monolithic structure whose integrity plays an important role in the pelvic organ function. Currently, pelvic floor peritoneum reconstruction (PFPR) is rarely performed during laparoscopic surgery for middle and low rectal cancer patients. This study evaluated the effect of PFPR using barbed wire during laparoscopic surgery on the postoperative defecation function in middle and low rectal cancer patients. This was a retrospective study involving a total of 252 middle and low rectal cancer patients who had been subjected to laparoscopic-assisted anterior resection of rectal cancer at Shanghai Changhai Hospital from March 2018 to April 2020. The Wexner and low anterior resection syndrome (LARS) scores were used to evaluate the postoperative defecation function among patients. A Wexner score ≥ 8 and LARS score ≥ 30 were considered to indicate major defecation dysfunction. A total of 229 patients (52 patients subjected to PFPR) were followed up, and the Wexner and LARS scores were recorded. The follow-up rate was 90.87%, the mean follow-up time was 22.88 ± 6.93months, the stoma rate was 64.29%, the ileostomy reduction surgical rate was 90.74%, and the stoma duration was 7.64 ± 2.94months. Regarding the assessment of postoperative defecation dysfunction using the Wexner score, a multivariate analysis revealed that a long operation time (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.984-0.999, p = 0.026) and radiotherapy (OR, 0.352; 95% CI, 0.156-0.797, p = 0.012) were independent risk factors for major defecation dysfunction, while a high tumor location (OR, 1.318; 95% CI, 1.151-1.657, p = 0.001) and PFPR (OR, 4.770; 95% CI, 1.435-15.857, p = 0.011) were independent protective factors for major defecation dysfunction. Regarding the assessment of the postoperative defecation function using the LARS score, a multivariate analysis revealed that a high tumor location (OR, 1.293; 95% CI, 1.125-1.486, p < 0.001) and PFPR (OR, 3.010; 95% CI, 1.345-6.738, p = 0.007) were independent protective factors for major defecation dysfunction. A subgroup analysis showed that the postoperative Wexner score (3.13 ± 2.79 vs. 4.71 ± 3.45 p = 0.003) and LARS score (21.77 ± 8.62 vs. 25.14 ± 8.78 p = 0.015) were lower for patients with PFPR than for patients without PFPR. Regarding patients with low rectal cancer, those with PFPR had a lower LARS score than those without it (23.62 ± 8.94 vs. 28.40 ± 7.90, p = 0.022), but there was no significant difference in the Wexner score between the groups. A total of 9.76% of patients with PFPR and 48.89% of those without PFPR showed an intestinal accumulation in the sacral front (p < 0.001). PFPR and a high tumor location are protective factors for postoperative defecation dysfunction in middle and low rectal cancer patients. PFPR can be routinely performed during laparoscopic surgery.

Risk Factors of Delayed Recovery of Gastrointestinal Function After Ileostomy Reversal for Rectal Cancer Patients.

PurposeThe aim of this study was to identify the risk factors associated with delayed recovery of gastrointestinal function after ileostomy reversal for rectal cancer patients.MethodsIn this retrospective study, the data of rectal cancer patients who underwent ileostomy reversal from January 2018 to December 2019 at the Sixth Affiliated Hospital of Sun Yat-sen University were assessed to investigate potential risk factors of delayed flatus after ileostomy reversal.ResultsA total of 282 patients were eligible for this study. Postoperative first flatus time ranged from 1 to 9 days, of which 58.8% patients presented with delayed flatus that was longer than 3 days. Univariate analysis showed that delayed postoperative flatus was significantly associated with the length of postoperative hospital stay (P<0.001) and postoperative complications (P=0.037). Multivariate analysis showed that intravenous fluid infusion at postoperative day 1 (POD1) (OR=1.001, 95% CI: 1.001–1.002, P=0.001) and duration of stoma ≥6 months (OR=2.005, 95% CI:1.155–3.657, P=0.014) were independent risk factors for delayed flatus.ConclusionIncreased intravenous fluid infusion at POD1 and duration of stoma ≥6 months were related to delayed recovery of gastrointestinal function after ileostomy reversal for rectal cancer patients.

Analysis of a Modified Two-Stage Approach to Ileal Pouch-Anal Anastomosis Without Fecal Diversion in Pediatric Patients

Fecal diversion after ileal pouch anal anastomosis (IPAA) in children with ulcerative colitis (UC) remains controversial. We hypothesize that a modified two-stage IPAA omitting diverting ileostomy (DI) after IPAA, found to be safe in adults, would produce similar results in children. Retrospective, single-institution study of children (≤18years) undergoing staged total proctocolectomy with IPAA from 2014 to 2020. Traditional two-stage and three-stage approaches including DI after IPAA were compared to two-stage approach without DI. 32 patients were included; of these, 7 (22%), 14 (44%), and 11 (34%) patients underwent traditional two-stage, modified two-stage, or three-stage IPAA, respectively. Following IPAA, modified two-stage patients had shorter operative time, decreased opioid utilization, quicker return to regular diet, and shorter stoma duration. After IPAA, there was similar postoperative length of stay, complication rates, readmissions, visits to the emergency department, or unplanned return to the operating room (OR) within 30days. Anastomotic leak occurred in 2 patients; both were managed nonoperatively without evidence of pouch dysfunction. Modified two-stage IPAA with omission of DI after the IPAA stage is safe to perform in pediatric UC patients. Prospective studies with larger sample sizes are needed to identify risk factors associated with operative complications.

Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignancy radiation

BackgroundChronic radiation proctitis (CRP) with rectal ulcer is a common complication after pelvic malignancy radiation, and gradually deteriorating ulcers will result in severe complications such as fistula. The aim of this study was to evaluate effect of colostomy on ulcerative CRP and to identify associated influence factors with effectiveness of colostomy.MethodsBetween November 2011 to February 2019, 811 hospitalized patients were diagnosed with radiation-induced enteritis (RE) in Sun Yat-sen University Sixth Affiliated Hospital, among which 284 patients presented with rectal ulcer, and 61 ulcerative CRP patients were retrospectively collected and analyzed.ResultsThe overall effective rate of colostomy on ulcerative CRP was 49.2%, with a highest effective rate of 88.2% within 12 to 24 months after colostomy. 9 (31.1%) CRP patients with ulcers were cured after colostomy and 12 (19.67%) patients restored intestinal continuity, among which including 2 (3.3%) patients ever with rectovaginal fistula. 100% (55/55) patients with rectal bleeding and 91.4% (32/35) patients with anal pain were remarkably alleviated. Additionally, multivariable analysis showed the duration of stoma [OR 1.211, 95% CI (1.060–1.382), P = 0.005] and albumin (ALB) level post-colostomy [OR 1.437, 95% CI (1.102–1.875), P = 0.007] were two independent influence factors for the effectiveness of colostomy on the rectal ulcer of CRP patients.ConclusionsColostomy was an effective and safe procedure for treating rectal ulcer of CRP patients, and also a potential strategy for preventing and treating fistula. Duration of stoma for 12–24 months and higher ALB level could significantly improve the effectiveness of colostomy on ulcerative CRP patients.

Lessons Learned About Peristomal Skin Complications

The aims of this study were to (1) describe the demographic and clinical characteristics of the individuals with peristomal skin complications (PSCs); (2) describe the PSCs; (3) examine the relationship of PSC occurrence and severity with possible risk factors, and (4) describe how PSCs were managed clinically. Secondary analysis of data from randomized controlled study, the ADVOCATE trial. Study participants (n = 153) were divided into 2 groups: those who did not experience a PSC (n = 80) and those who did (n = 73). A participant was considered to have sustained a PSC during the original study if his or her Discoloration, Erosion, and Tissue score increased above the baseline score. Demographic and pertinent characteristics of participants with and without PSCs were compared. In addition, data from the 73 participants who sustained PSCs were further analyzed to characterize and describe the PSCs, to investigate potential risk factors associated with the occurrence and severity of a PSC, and for clinical management. Group comparisons were made via t tests for continuous variables, χ test or Fisher exact test for categorical variables, and generalized linear models for identification of risk factors. The majority of the PSCs were mild or moderate in nature, and they were most commonly categorized by the investigators as irritant dermatitis. Two risk factors were associated with an increased likelihood of experiencing a PSC: stoma duration and peristomal skinfold or creases. Within the study period, the odds of sustaining a PSC increased over time and the presence of skinfolds or creases increased the likelihood of PSCs. Peristomal skin complication severity was likely to be worse with an ileostomy and less severe as stoma duration increased. Products used to manage PSCs consisted of barrier rings/seals, skin barrier powder, and paste or paste strips. Ileostomy is associated with higher risk of a severe PSC and peristomal skin creases or folds. Patient follow-up should be on a structured schedule beyond the first few weeks after surgery because the likelihood of getting a PSC increases over time. This approach may help improve outcomes, particularly for those with an ileostomy and challenging skin contours.

Family Functioning, Perceived Social Support, and Adaptation to a Stoma: A Descriptive, Cross-sectional Survey

The aim of this study was to examine the relationships among family functioning, perceived social support, and adaptation to living with a stoma. A descriptive, cross-sectional survey was conducted between October 2013 and June 2015 among consecutive patients who visited the stomatherapy unit of a university hospital in Ankara, Turkey, for regular follow-up visits. Eligibility criteria stipulated participants must be at least 18 years of age, literate, live with family, have their stoma for at least 2 months, and be willing to participate. Instruments included a demographic and stoma-related information form, the Multidimensional Scale of Perceived Social Support (MSPSS; subscale range 4-28, total score range 12-84; higher scores indicate better perceived support), the McMaster Family Assessment Scale (FAS; range 1.32-3.15; higher scores indicate deteriorating family function), and the Ostomy Adjustment Inventory Scale-23 (OAI-23; range 19-85; higher scores indicate increasing adaptation). Data were entered into statistical software for analysis that included descriptive statistics and Mann-Whitney U and Spearman correlation tests. Among the 75 participants (mean age 55.4 ± 12.96 years; average stoma duration 3.77 ± 4.97 years), 41 (54.7%) were male, 59 (78.7%) were married, and mean duration of living with a stoma was 3.77 ± 4.97 years. The average MSPSS score was 61.0 5 ± 15.00, the average FAS score was 1.98 ± 0.38, and the average OAI-23 score was 49.39 ± 14.62, all within the "moderate" range for their measures. Stoma complications, time since surgery, stoma self-care, marital status, whether the surgery was planned or an emergency, and employment status significantly affected MSPSS, FAS, and OAI-23 scores. As the FAS scores increased, the MSPSS (r = -.399; P = .001), and OAI-23 (r = -.300; P = .009) scores decreased. The results suggest wound, ostomy, continence nurses should assess and encourage familial and social support. Prospective studies examining the effect of familial and social support on stoma adjustment are warranted.

PMD50 COMPARING THE ABILITY OF TWO INNOVATIVE OSTOMY BAGS TO PREVENT BALLOONING IN A REAL-LIFE SETTING

Ballooning occurs when air from the digestive system is trapped in the ostomy bag causing it to inflate. This has been shown to negatively impact user QOL due to discomfort/sleep problems. This study aims to compare ballooning-rates between patients using stoma bags with different filter-technologies, Sensura Mio® (SM) and Moderma® (M) one-piece bags. This is a retrospective observational study including patients using either a SM or M. Data is collected via a community-based patient support programme in the UK. We use multivariable logistic regression to estimate the odds-ratio for ballooning and control for differences in age, gender, stoma type, stoma duration and other stoma related complications. Four sub-models were estimated as sensitivity analysis. 564 SM users and 125 M users were enrolled from 2016 to 2018. Mean age (yr) was 66.9 and 69.6 for SM and M respectively, 49% and 52% were female, 54.3% and 59.5% were ileostomists, 45.7% and 40.5% were colostomists 2.6% and 8.7% of SM and M users respectively identified ballooning as an issue. 23.0% and 33.0% of SM and M users experienced leakage while 23,2% and 27.0% experienced parastomal skin complications. The estimated adjusted odds-ratio for living with ballooning issues when using SM compared to M is OR=0.32 [CI: 0.19-0.49] in the main analysis and between OR=0.27 and OR=0.32 in the sensitivity analysis (all statistically significant), corresponding to a 68% reduction in ballooning events for SM. SM-users have significantly fewer ballooning-events than M-users and hence experience potentially improved QoL. The strength of this study is the large number of patients included and the real-life setting while the observational nature of the design is a limitation.

Investigation of the sleep quality at home of the postoperative patients with fecal ostomies

Objective To investigate the sleep quality at home and the influencing factors in patients with colorectal tumor after enterostomy. Methods Using convenience sampling method, during March 2016 to December 2017 in Anhui Provincial Cancer Hospital wound and stoma outpatient, choose 276 patients with enterostomy (including temporary enterostomy and permanent enterostomy), using self-made general questionnaire ostomy, Pittsburgh Sleep Quality Index (PSQI) and self nursing competence scale to investigate them. Results The total PSQI score of enterostomy patients was 6.39±4.07, among which 150 patients (57.0%) had poor sleep (PSQI>7). The score of the 7 dimensions of PSQI from high to low was sleep time (1.22±1.05), sleep time (1.12±0.98), subjective sleep quality (1.00 ±0.92), sleep disorder (1.02±0.95), sleep efficiency (0.95±0.43), daytime dysfunction (0.83±0.76), hypnotic drugs (0.25±0.24).There were statistically significant differences in sleep quality among patients with different ages (Z=-2.937), duration of stoma (t=3.450-3.896), types of stoma (t=3.998-4.011), whether or not they had a history of leakage within 1 month (t=3.454-6.774), whether or not they had bloating bags (t=3.230-4.001), stoma complications (t=2.976-3.582), enterostomy self-care knowledge (Z=-3.202, t=3.971) and nursing skills (t=3.061)(P<0.05). Conclusions The present study shows that the sleep quality of patients with enterostomy is generally poor, and targeted measures should be taken to reduce its incidence or to intervene in time. Key words: Enterostomy; Sleep quality; Quality of life

Reduction in surgical stoma rates in Crohn's disease: a population-based time trend analysis.

Trends in surgical rates for Crohn's disease (CD) in the biological era are controversial. We aim to assess modern trends in the formation rates of surgical stomas. Population-based surveillance in the Calgary Health Zone (CHZ), Canada, was conducted between 1 April 2002 and 31 March 2011, using the Discharge Abstract Database to identify adult patients with CD admitted to hospital and treated with surgical stoma formation (n=545). Annual stoma incidence was calculated by dividing the number of incident stomas by the prevalence of CD in the CHZ. Time trend analysis of the stoma-formation rate was performed, expressed as annual percentage change (APC) with 95% CI. Stoma-formation rates were stratified according to procedure (emergency vs elective) and duration of stoma [temporary (reversed within 2years of formation) vs permanent]. The overall rate of stoma formation between 2002 and 2011 showed a downwards trend, of a mean of 5.2% (95% CI: -8.5 to -1.8) per year, from a rate of 2.30 stomas/100 person-years (PY) in 2002 to 1.51 stomas/100PY in 2011. The rate of emergency stoma formation decreased significantly from 2002 to 2011 (mean APC = -9.4%; 95% CI: -15.6 to -2.8), while the rate of elective ostomies essentially showed no change (mean APC = -0.9%; 95% CI: -5.3 to 3.8). The rate of temporary stoma formation decreased significantly, by 4.6% (95% CI: -7.3 to -1.8) per year, while permanent stoma formation was stable (APC=1.0%; 95% CI: -4.0 to +6.3). A reduction in the overall rate of stoma formation in CD has been driven by fewer emergency stomas, although rates of permanent stoma have remained stable.