Undergoing Ostomy Surgery Research Articles

The Effectiveness of Development mHealth Apps on the Self-Care Ability of Patients with Ostomy.

Intestinal cancer, severe injury, and severe inflammation are most often treated with surgery, and an ostomy will be left in place after surgery[1]. An ostomy is a portion of the intestine that is surgically removed and pulled up to the abdominal wall, creating a temporary or permanent opening that serves as a pathway for intestinal waste to be discharged from the body, usually called a stoma. Stoma may be temporary (2 months to 6 months) or permanent. The goal for people with a stoma is to have the knowledge and ability to care for an ostomy to avoid peristomal moisture-associated skin damage. After patients return home, self-care knowledge and skills can help them adapt to the disease and maintain quality of life. Therefore, this study examined the effects of developing mobile Health applications on improving self-care knowledge and skills in patients who underwent ostomy surgery.

Effectiveness of a Community-Based Ostomy Nursing Technique to Enhance the Delivery of Patient Care and Quality of Life

ABSTRACT This study aimed to develop and validate a community-based ostomy care training program for nursing staff, with the goal of enhancing their ostomy nursing competencies and improving patient satisfaction. Between March 2021 and October 2021, 20 registered nurses and 50 patients with enterostomy surgery who took part in the promotion of a new nursing technique in five community health service centers in the Wuxing District, Huzhou City, were enrolled in this study (forming the intervention group). In addition, 15 registered nurses and 40 patients with enterostomy surgery from four community health service centers with similar economic and health conditions in the same area were randomly selected as the control group. All community health service centers were independent institutions. The indexes before and after the promotion of the technique were compared, and the effectiveness of the training was evaluated by observing the improvement in nursing skills and changes in patient quality of life after the training. The “quality-of-life scale” was used to analyze the quality of life of patients who had undergone colostomy surgery. The new approach to ostomy care delivered in a community setting was found to improve staff knowledge and skill in ostomy care (p < 0.001), improve the quality-of-life scores of patients and reduce patient travel time and medical expenses. The promotion of ostomy nursing techniques in community health service centers has several benefits. It improves the ostomy nursing skill levels of community medical staff. This reduces the occurrence of ostomy complications. Additionally, it establishes an effective connection between tertiary hospitals and community health service centers. This connection is conducive to better nursing care for patients who have undergone ostomy surgery. The hospital – community – family nursing model can improve self-management abilities and reduce the incidence of complications of enterostomies.

"I Am Half of a Person": Lived Experiences of Individuals Living With Ostomy After Surgery in Rural Haiti.

Intestinal ostomy can have significant effects on lives and lived experiences. However, limited research exists on the experiences of persons with ostomy in low-resource settings, such as rural Haiti. This study aimed to explore the lived experiences of Haitians with an ostomy, focusing on the physical, psychological, and social aspects of their post-operative lives. We conducted 9 semi-structured, in-depth interviews with participants who had undergone ostomy surgery at the Hôpital Universitaire de Mirebalais in Haiti. Employing interpretative phenomenological analysis (IPA), we iteratively examined transcripts to identify convergent and divergent codes, which were then grouped into themes to better understand the participants' experiences. Three themes emerged: (a) ostomy as a social disease, which has severe impacts on relationships and place in society; (b) ostomy as altering self-image, leading participants to reflect on their identity and the underlying causes of their condition and to reevaluate their necessities and abilities; and (c) ostomy as an arduous medical journey, characterized by pain, distress, uncertainty, and disillusionment, but also resiliency, improvisation, and hope. This study highlights the multifaceted experiences of persons with ostomy in the low-resource rural environment of Haiti and underscores the need for improved access to medical care, financial support, and psychosocial and caregiving resources for these individuals. Findings also emphasize the importance of medical providers' improved understanding in making medical decisions, and cultural and socioeconomic factors in developing effective support strategies.

Quality of life in ostomy patient.

Background: The patient undergoing ostomy surgery experiences changes in multiple areas of their life related to their altered self-perception. In addition to potential postoperative complications, they face significant physical, physiological, psychological, and social changes that directly affect their physical and mental health. An ostomy is a process that saves thousands of lives every day and offers a second chance to patients suffering from diseases such as colorectal cancer, visceral perforation, diverticula, Crohn's disease, ulcerative colitis, and others. It involves redirecting a hollow viscus to the surface of the body in a location different from its natural opening, creating an opening on the surface of the body called a stoma, which diverts the intestinal transit. The patient will require a collecting bag for bodily waste. Currently, there are multiple investigations aimed at assessing the quality of life related to the health of patients who have undergone this surgical intervention, and the concerns they experience in their day-to-day lives. Therefore, this systematic review analyzed the literature in order to determine the perceived impact on quality of life related to health in ostomized patients. Material and methods: A systematic retrospective search was conducted in the following databases: PubMed (MEDLINE), TripDatabase, CINAHL, Cochrane Library, Google Scholar and PsycINFO. The MESH search terms used in this study were: Colostomy; Stoma; Ostomy; Ileostomy; Quality of life; Complications; Adaptations; Problems. Using the Boolean operators OR and AND. A total of 527 articles were obtained as a result, of which 17 articles met the inclusion criteria of this study. Results: A total of 9308 patients were studied, 55.65% of whom were men and 44.34% were women. 73.53% underwent colostomy procedures, while 24.15% underwent ileostomy, 76.28% maintained a permanent ostomy, and 20.93% had a temporary ostomy. Of the total number of studies evaluated, it was observed that ostomized patients had a clear alteration in quality of life in one or more of the analyzed variables. Conclusion: The quality of life of ostomy patients is severely impacted. Among the analyzed variables, the causes of this finding were: changes in body image, lack of control over bowel evacuation, unpleasant odors, unpleasant sounds, constipation, and leaks. The consequences of these findings were: disruptions in physical self-perception, psychological, social, and emotional alterations, low self-esteem, depressive feelings, changing clothing, difficulties traveling, social isolation, deterioration of the family role, and insecurity in managing their ostomy.

Benefits of a Single-Session, In-Hospital Preoperative Education Program for Patients Undergoing Ostomy Surgery: A Randomized Controlled Trial.

The purpose of this study was to compare the effects of a 45-minute session of video-based preoperative ostomy education on self-care knowledge, self-care proficiency, anxiety, depression, length of hospital stay, and ostomy-related complications to a control group who received 3 postoperative educational sessions. This was a randomized controlled trial. The sample comprised 47 patients scheduled to undergo ostomy surgery for colon or rectal cancer surgery at a tertiary referral hospital in Seoul, South Korea, from November 2018 to May 2019. However, 2 participants in the intervention group and 4 in the control group withdrew from the study and data analysis is based on 41 participants who completed study procedures. Participants were randomly allocated to an intervention group (n = 21) or a control group (n = 20). The intervention group received a single 45-minute session of video-based preoperative ostomy education along with stoma site marking and postoperative education. The control group underwent stoma site marking and 3 postoperative education sessions Self-care knowledge, anxiety, and depression were assessed by validated instruments. Self-care proficiency was assessed via direct observation using a checklist. Ostomy-related complications were evaluated by a WOC nurse. Length of hospital stay and disease-related characteristics were collected from medical records. Compared with the control group, the intervention group showed significant improvements in self-care knowledge (P = .001) and self-care proficiency scores (P = .001). Intervention group participants also had lower anxiety scores (P = .025), depression scores (P = .014), shorter hospital stays (P = .008), and fewer ostomy-related complications (P = .001). In patients undergoing ostomy surgery, a single 45-minute session of preoperative video-based ostomy education improved self-care knowledge and proficiency. This intervention also reduced depression, anxiety, and ostomy-related complications.

Effects of sleep hygiene education and lavender oil inhalation on sleep quality, fatigue, and health-related quality of life in adults with an ostomy: a randomized controlled trial protocol

Background: It has been shown that the formation of an ostomy affects sleep quality, and sleep problems or insomnia cause fatigue in daily life, reducing the health-related quality of life. This trial aims to investigate the effects of sleep hygiene education and lavender oil inhalation alone and in combination on sleep quality, fatigue, and health-related quality of life in adults with an ostomy. Methods: This trial has been planned as a randomized controlled clinical trial and will use a 2×2 factor design in which an equal number of participants meeting the inclusion criteria will be randomly allocated to one of four groups. The study sample will comprise 120 adult patients who have undergone ostomy surgery in a city hospital in Turkey. Lavender oil inhalation together with sleep hygiene education will be applied in the first group (n=30), only sleep hygiene education in the second group (n=30), only lavender oil inhalation in the third group (n=30), and no intervention in the fourth group (n=30). The sleep quality of the groups will be evaluated using the Pittsburgh sleep quality index, their fatigue levels with the chalder fatigue scale, and their quality of life with the ostomy a quality-of-life scale. Conclusions: Non-pharmacological interventions are needed to prevent sleep and/or other problems that may develop due to insomnia in adults with ostomy. By evaluating the effects of these interventions, this trial will provide valuable evidence to guide clinical practice. Trial registration: This trial was registered in October 2022 (NCT05573256).

Characteristics, Hospital Length of Stay, and Readmissions Among Individuals Undergoing Abdominal Ostomy Surgery: Review of a Large US Healthcare Database.

The purpose of this study was to examine patient characteristics, length of stay (LOS), hospital revisits, and complications of patients undergoing abdominal ostomy surgery. Retrospective cohort study. Data were extracted from the PINC AI Healthcare Database (PHD), a large archive that stores data from 25% of all US inpatient hospital discharges. Patients were admitted to 658 hospitals in the United States between December 1, 2017, and November 30, 2018. The sample comprised 27,658 adult patients; 15,512 underwent creation of a colostomy, 10,207 underwent ileostomy construction, and 1930 had a urostomy procedure. Their median age was 64 years (interquartile range [IQR] = 19 years). Emergent admission type was 71.2% for patients who underwent a colostomy procedure, 49.4% for ileostomy, and 9.9% for urostomy. The majority of patients underwent open surgery (77.7%); 22.3% of procedures used an endoscopic approach. Patients were identified as having undergone abdominal ostomy surgery via ICD-10-PCS (International Classification of Diseases, Tenth Revision, Procedure Coding System) procedure codes. Demographic, visit, hospital and clinical characteristics, LOS, and hospital revisits (ie, readmissions and emergency department [ED]) were captured for qualifying patients. Data were evaluated using unadjusted descriptive analyses. The median LOS of 9 days (IQR = 9 days) varied by ostomy surgery; the cumulative postsurgical LOS was 7 days (IQR = 5 days). The most frequent underlying diagnoses resulting in ostomy surgery were diverticulitis of the large bowel (19.6%) managed by colostomy, colorectal cancer managed by ileostomy (22.5%), or urothelial cancer managed by urostomy (78.1%). Slightly less than a quarter (23.7%) of patients were discharged home without home care, 43.0% went home with home healthcare, and 29.6% were discharged to a non-acute care facility. Hospital readmission within 120 days of discharge was 36.3% for patients with a colostomy, 52.3% for those with an ileostomy, and 34.6% for patients with a urostomy. Ostomy complications were identified as the reason for readmission in 62.4% of patients. Slightly more than 1 in 5 patients (20.7%) had a subsequent ED visit within 120 days, 39.7% of which involved ostomy complication. Characteristics of patients undergoing abdominal stoma surgery varied based on underlying diagnosis and ostomy type. The median hospital LOS was more than 1 week. Patients experienced high rates of healthcare utilization (hospital admission or ED visits) during the 120 days following surgery.

A Cross-Sectional Survey Reporting on the Value of Patient-Centered Ostomy Programs: A Smooth Transition After Ostomy Surgery.

PURPOSE:The purpose of the study was to evaluate a postsurgical ostomy patient support program in regard to postsurgical experience, education, skin care, pouching system and accessory use, insurance issues, supplier assistance, hospital readmission status, and the benefit of multiple interactions.DESIGN:Cross-sectional design.SUBJECTS AND SETTING:Potential respondents were randomly selected from a group of adults 18 years or older who underwent ostomy surgery within 6 months prior to survey completion. Nine hundred seventy-one individuals met inclusion criteria, and 297 were selected for analysis, based on having 1 or more program interactions. Data were collected between the second and third quarters of 2020. All participants were residents of the United States.METHODS:Participants were contacted by e-mail containing an invitation to participate in a survey; the e-mail also described the intent of the survey. Survey distribution was conducted by the sponsor and linked to a third-party survey management organization for compilation. The survey questionnaire, developed specifically for the purpose of this study, comprised 73 items that queried demographic and pertinent clinical data, participation in an industry-sponsored patient support program, and their post–hospital discharge experiences including unplanned health care provider visits, emergency department visits, and hospital readmissions.RESULTS:Eighty-three percent (n = 237) of respondents did not have postsurgical ostomy-related emergency department visits, 75% (n = 223) did not have related unplanned physician visits, and 90% (n = 268) did not have related hospitalizations. Participants with 2 or more interactions were more likely to contact a program representative for issues of stoma care, leakage and skin care, ostomy products/accessories, and supplier issues than their single-interaction counterparts.CONCLUSIONS:Study findings suggest that patients with new ostomies benefited from engagement in an industry-sponsored patient support program. The benefit appears to arise from personal interactions and respondents; 2 or more interactions were shown to have greater benefit than a single interaction.

WOCN Society, AUA, and ASCRS Position Statement on Preoperative Stoma Site Marking for Patients Undergoing Ostomy Surgery.

ORIGINATED BY: Wound, Ostomy, and Continence Nurses Society™ (WOCN®) Stoma Site Marking Task Force in collaboration with the American Society of Colon and Rectal Surgeons (ASCRS) in 2007. UPDATED/REVISED BY: WOCN Society's Stoma Site Marking Task Force in collaboration with the ASCRS and the American Urological Association (AUA) in 2015 and 2021. TASK FORCE CHAIR Ginger Salvadalena, PhD, RN, CWOCN, Hollister Incorporated, Libertyville, Illinois. [email protected] TASK FORCE MEMBERS Christine Baker, MSN, APRN, CWOCN University of Chicago Comer Children's Hospital, Chicago, Illinois Carole Bauer, MSN, RN, ANP-BC, OCN, CWOCN Beaumont Health System, Troy, Michigan Janice Colwell, APRN, CWOCN, FAAN, University of Chicago Medicine, Chicago, Illinois Daniel L. Feingold, MD, FACS, FASCRS, Rutgers University, New Brunswick, New Jersey Vashti Livingston, MS, RN, CWOCN, DAPWCA, Memorial Sloan Kettering Cancer Center, New York City, New York Michael F. McGee, MD, FACS, FASCRS, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Leanne Richbourg, MSN, APRN-BC, CWON-AP, CCCN, GCNS-BC Duke University Hospital, Durham, North Carolina Elizabeth Savage, MSN, RN, ACNS-BC, CWON, IIWCC-NYU NYU Langone Health, New York City, New York Gary D. Steinberg, MD Perlmutter Cancer Center, NYU Langone Health, New York City, New York WOCN SOCIETY SUPPORT Anna Shnayder Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (JWOCNOnline.com).

The safety of surgical technique for ileostomy and colostomy in preventing parastomal hernias: an in vitro experimental simulation study

BackgroundParastomal hernia (PH) is a common long-term complication in persons with an ostomy. Although the cause of PH may be multifactorial, the surgical technique employed for the creation of a stoma may be a risk factor for the development of PH. The traditional technique of cruciate fascia incision may predispose to increased pressure zones at the ostomy exit site, thereby increasing the risk of PH. A circular excision of the abdominal fascia at the ostomy exit site enables a uniform pressure distribution, thereby reducing the risk of PH. This hypothesis was tested in this in vitro experimental simulation study.MethodsThe effect of the surgical technique for ostomy creation on the risk of PH development was investigated in this in vitro experimental simulation study. The pressure development at the stoma site was compared for the traditional cruciate incision vs. circular fascia excision.ResultsThe pressure at the ostomy site was about four-times higher in the tradition cruciate incision technique compared to the circular excision technique. This finding was independent of unilateral (e.g. peritoneal) pressure application.ConclusionThe main finding from this study suggests that the traditional cruciate incision of the abdominal fascia for the creation of an intestinal ostomy predisposes to increased pressures at the ostomy site, thus increasing the risk of PH. This effect is not seen in the experimental setting following a circular excision of the fascia. Thus, this surgical aspect may be adopted as a possible means of reducing the risk of parastomal hernia in patients undergoing ostomy surgery.

The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy\u2014protocol of a systematic review and meta-analysis

BackgroundAn intestinal ostomy is an artificial bowel opening created on the skin. Procedure-related mortality is extremely rare. However, the presence of an ostomy may be associated with significant morbidity. Complications negatively affect the quality of life of ostomates. Preoperative stoma site marking can reduce stoma-related complications and is recommended by several guidelines. However, there is no consensus on the procedure and recommendations are based on low-quality evidence.The objective of the systematic review will be to investigate if preoperative stoma site marking compared to no preoperative marking in patients undergoing intestinal stoma surgery reduces or prevents the rate of stoma-related complications.MethodsWe will include (cluster-) randomised controlled trials and cohort studies that involve patients with intestinal ostomies comparing preoperative stoma site marking to no preoperative marking and report at least one patient-relevant outcome. For study identification, we will systematically search MEDLINE/PubMed, EMBASE, CENTRAL and CINHAL as well as Google Scholar, trial registries, conference proceedings and reference lists. Additionally, we will contact experts in the field. Two reviewers will independently perform study selection and data extraction. Outcomes will be prioritised based on findings from telephone interviews with five ostomates and five ostomy and wound nurses prior to conducting the review. Outcomes may include but are not limited to stoma-related complications (infection, parastomal abscess, hernia, mucocutaneous separation, dermatological complications, stoma necrosis, stenosis, retraction and prolapse) or other patient-relevant postoperative endpoints (quality of life, revision rate, dependence on professional care, mortality, length of stay and readmission). We will use the ROBINS-I or the Cochrane risk of bias tool to assess the risk of bias of the included studies. We will perform a meta-analysis and assess the certainty of evidence using the GRADE approach.DiscussionWith the results of the systematic review, we aim to provide information for future clinical guidelines and influence clinical routine with regard to preoperative stoma site marking in patients undergoing ostomy surgery. When the evidence of our systematic review is low, it would still be a useful basis for future clinical trials by identifying data gaps.Systematic review registrationPROSPERO registration number: CRD42021226647

The Use of a Stoma Rod/Bridge to Prevent Retraction: A Systematic Review.

We evaluated evidence related to the use of a rod (bridge) to prevent stoma retraction during loop ostomy construction. We completed a systematic review of the literature. We searched MEDLINE, EMBASE, and COCHRANE databases up to December 4, 2019. We posed the following question based on a PICO format. Do adult patients undergoing ostomy surgery experience less stomal retraction when compared to patients managed without placement of a stoma rod? Our initial search returned 182 articles; after reading studies in full, 5 articles were identified that collectively enrolled 1058 participants. Four studies were randomized controlled trials and one was a prospective cohort study. Meta-analysis could not be performed because of the small number of studies and the heterogeneity of outcomes measurements. The incidence of stoma retraction ranged between 0%-8% in patients managed with a rod and 0.78%-8.2% in patients with no rod. The number of reported adverse events was low. Placement of a stoma rod was associated with more adverse outcomes than in patients managed without a rod. Adverse events included local edema, stoma necrosis, skin necrosis, peristomal moisture-associated skin damage (irritant dermatitis), peristomal abscess, bleeding, and mucocutaneous separation. Stoma rod does not seem to reduce the risk of stoma retraction and might result in other adverse events. We recommend avoidance of stoma rod/bridge placement during ostomy surgery.

Effect of Educational Program on Nurses Performance about Colostomy Care

Background: Colostomy is a stoma which is formed after removing the large bowel or colon and is opening in the abdominal wall that’s made during surgery. The care of patients with colostomy is a complex, challenging and lengthy process .The nurse can play a clinically relevant role in the care of patient undergoing ostomy surgery pre and post-operative education. Aim of the study: to evaluate effect of educational program on nurses' performance about colostomy care. Subjects &Methods: Research design: a quasi-experimental design was utilized to fulfill the purpose of this study. Sample: Randomized sample conducted on 40 nurses caring for patient with colostomy .Setting: two setting: 1st setting at Oncology Center &2ndsetting at Minia University Hospital. Tools: Two tools were used for data collection: First Tool: included two parts: part I: socio demographic data sheet for the nurses, part II: structured knowledge questionnaire second tool: observational checklist about colostomy care. Results: Reveled that the mean age of study sample was 32.95 ± 3.65, the majority (85%) of the studied sample had low knowledge before educational program implementation while, after 3 months of program implementation the majority (85%) had a good knowledge about colostomy care. Also all of study sample had weak performance before educational program implementation while, in post immediately of program implementation more than half of studied sample (52.5%) had accepted performance and after 3 months the majority of them had a good performance about colostomy care. Also, there was a highly statistically significant difference in nurses' knowledge and practice pre & post immediately and after 3 months educational program regarding colostomy care. Conclusion: The study concluded that, there was a positive effect of the educational program in improving nurses' knowledge and practices regarding colostomy care. Recommendations: Greater attention and closely observation from hospital on nurses′ performance during care for patient with colostomy and replication of the study should be done on a large sample.

Ostomy Care During Hospital Stay for Ostomy Surgery and the United Ostomy Associations of America Patient Bill of Rights: A Cross-sectional Study.

The purpose of this study was to determine whether ostomy patients are receiving ostomy care pre- and postoperatively in accordance with the United Ostomy Associations of America Ostomy and Continent Diversion Patient Bill of Rights. Descriptive, quantitative study. The sample comprised 325 participants with an ostomy living in the United States. All participants underwent ostomy surgery in the United States. Participants were recruited through a purposive, nonprobability sampling method based on the presence of an ostomy and the ability to read and understand English. Data were collected between summer 2017 and fall 2018 from ostomy support groups (online and in-person support groups). Respondents completed a self-administered online questionnaire, which included closed-ended and open-ended questions. Forty percent (n = 127) of participants reported not being supervised changing their pouch before discharge. Forty-two percent (n = 137) reported receiving only hands-on instruction on how to care for their ostomy after surgery (no reading materials, nor video tutorial). Slightly more than half (52%; n = 170) reported not receiving support group information, and only 14% (n = 46) indicated participating in a discussion on intimacy concerns. The study demonstrates that ostomy care at the hospital can improve. Receiving an ostomy is a life-changing operation, and the first line of support for ostomy patients is their provider. Future research should examine ostomy care from providers' perspectives and, prospectively, in order to test care measures on patient health outcomes.

When do defecation function and quality of life recover for patients with non-ostomy and ostomy surgery of rectal cancer?

BackgroundRectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. This study aimed to examine defecation function and QOL in RC patients who underwent non-ostomy or ostomy surgery, at different time-points after surgery.MethodsIn total, 82 patients who underwent an ostomy and 141 who did not undergo an ostomy for the treatment of RC at our colorectal surgery department between January 2013 and January 2015 were enrolled. Surgical methods, tumor distance from the anal margin (TD), anastomosis distance from the anal margin (AD) and complications were compered between the non-ostomy and ostomy surgery groups. QOL was compared between the two groups at years 2, 3, and 4 after surgery. The Wexner score and the validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) questionnaire scores were assessed for all patients in January 2017. SPSS 21.0 was utilized for all data analyses.ResultsSurgical methods, TD, and AD significantly differed between the non-ostomy and ostomy surgery groups (all P < .001). However, no differences were found in the number of complications between the groups (P = .483). For the 192 patients undergoing Dixon surgery, role function (RF), global QOL (GQOL), sleep disturbance, and the incidence of constipation showed significant differences between the two groups (P = .012, P = .025, P = .036, and P = .015, respectively). In the 31 cases of permanent ostomy, we observed significant differences in GQOL scores, dyspnea incidence, and financial difficulties across the different years (P = .002, P = .036, and P < .01, respectively). Across all 223 cases, there were significant differences in social function and GQOL scores in the second year after surgery (P = .014 and P < .001, respectively). However, no differences were observed in the other indices across the three time-points.ConclusionsRC patients undergoing ostomy surgery, especially those with low and super-low RC, revealed poorer defecation function and QOL in the present study. However, 2 years after surgery, most of the defecation and QOL indicators showed recovery.

Factors influencing health-related quality of life of those in the Netherlands living with an ostomy.

this study examined the health-related quality of life (HRQoL) and wellbeing of people in the Netherlands who had undergone ostomy surgery. to assess how an ostomy population perceives their HRQoL and determine key stressors that influence HRQoL in this population. a cross-sectional survey, including the City of Hope National Medical Center Quality of Life Questionnaire for patients with an ostomy and a Visual Analogue Scale measuring HRQoL, was used to evaluate postsurgical patients. people with an ostomy in the Netherlands have a generally positive HRQoL, but this may be affected by peristomal skin irritation, experience of leakage on to the peristomal skin and whether their surgery was planned. access to specialist nurse support and products designed to prevent leakage and prevent skin irritation-two key drivers of HRQoL-may be able to maximise an individual's health status throughout their lifelong journey as a person with an ostomy.

Stoma Bridge Types and Their Impact on Patient Outcomes: A Retrospective Analysis and Prospective Global Survey of Surgical Practice.

The purpose of this study was to describe the effect of rigid or flexible stoma bridges used for loop ostomy diversions on peristomal skin integrity. Additional aims were to describe surgeon practices related to stoma bridges, and determine the availability of an ostomy nurse specialist. Retrospective chart review and cross-sectional survey. The sample used to address the first aim (effect of stoma bridges) comprised 93 adult patients cared for at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, an acute care facility. Data provided by 355 colorectal surgeons from 30 countries were used to describe surgeon practice in this area and determine the availability of an ostomy nurse specialist. Respondents were invited from an international roster of colorectal surgeons obtained with permission from the American Society of Colon and Rectal Surgeons (ASCRS). In order to accomplish the initial aim, we retrospectively reviewed medical records of patients who underwent ostomy surgery from 2008 to 2015 and met inclusion criteria. In order to meet our additional aims, analyzed data were obtained from a survey of colorectal surgeons that queried practices related to stoma bridges, and availability of an ostomy nurse specialist. Patients managed with a rigid bridge were significantly more likely to experience leakage beneath the pouching system faceplate than were patients managed by a flexible bridge (42% vs 11%, P < .001). Slightly less than one quarter of patients who developed leakage (n = 22, 24%) experienced pressure and moisture-related peristomal skin complications. Peristomal wounds, inflammation, and infection were significantly higher when a rigid bridge was used (χ test, P < .003). The surgeon's survey (N = 355) showed variability in the use of bridges. Ninety-three percent of all surgeons indicated an ostomy nurse specialist was part of their health care team. Rigid ostomy bridges were associated with a higher likelihood of leakage from underneath the faceplate of the pouching system and impaired peristomal skin integrity. Analysis of colorectal surgeon responses to a survey indicated no clear consensus related to bridge use in patients undergoing loop ostomies.

PGI20 A REPORT ON THE QUALITY OF LIFE OF OSTOMATES IN THE NETHERLANDS

The creation of an abdominal stoma for the discharge of bodily waste is a life-altering event. This study examined the quality of life (QoL) and wellbeing of those living in the Netherlands that have undergone ostomy surgery. A cross-sectional survey was developed to assess a random selection of post-surgical patients residing in the Netherlands. This study included questions from The City of Hope Ostomy Quality of Life Survey allowing an assessment of physical, psychological, social, and spiritual well-being. Data was collected from 2127 respondents providing a margin of error of 2.1 percent and found to be highly reliable (Cronbach’s alpha 0.9157). Fifty-five percent of the respondents were colostomates, 25% ileostomates, 17% urostomates, 2% have multiple stomas, and <1% did not know their stoma type. The respondents have an average age of 64.1 years, and an average time from surgery of 6.6 years. When responding to questions pertaining to specific QoL domains, on a scale of 0 to 10, where 10 equals best possible, Physical well-being was given an average rating of 7.65; Psychological well-being 7.19, Social well-being 6.86, and Spiritual well-being 5.85. Other aspects of the individuals’ life with a stoma were queried, including concerns with body image, skin irritation around their stoma, and issues with their skin barrier. 58% indicated they usually have some degree of irritated skin around their stoma and stated leakage under the barrier was the primary problem, with ballooning being the second most common problem (with the exception of urostomates). Overall, this study finds that the participants sampled, as a representation of the people with an ostomy in the Netherlands, enjoy a quality of life similar to that experienced in other countries. The study also found that on the whole, the respondents are well adjusted and knowledgeable regarding their stoma.

Peristomal Moisture-Associated Skin Damage and Independence in Pouching System Changes in Persons With New Fecal Ostomies.

PURPOSE:The purpose of this study was to evaluate factors related to peristomal moisture-associated skin damage (MASD) in patients who underwent ostomy surgery because of colorectal cancer, and their independence in pouching system changes. Findings were used to determine pre- and postsurgical care for these patients.DESIGN:Retrospective review of medical records.SUBJECTS AND SETTING:The study setting was an 800-bed hospital in metropolitan Tokyo, Japan. The sample comprised 89 patients (median age: 65 years; male vs female: 58 vs 31) who visited a stoma clinic within 8 weeks of ostomy surgery. Fifty-two subjects had ileostomies and 37 had colostomies; data were collected between January 2008 and July 2014.METHODS:Data were collected from outpatient and inpatient records. Potential relationships between MASD and independence in pouching system changes were evaluated via univariate tests to identify possible associations, followed by logistic regression analysis.RESULTS:Patients living with an ileostomy were more likely to experience peristomal MASD than were patients living with a colostomy (odds ratio [OR] = 3.782; 95% confidence interval [CI]: 1.34-10.64; P = .012). Analysis also found that patients with postsurgical chemotherapy were more than 2.5 times more likely to experience peristomal MASD than patients who did not require postoperative chemotherapy (OR = 2.702; 95% CI: 1.02-7.18; P = .046). We also found that patients 65 years or older were significantly more likely to have difficulty in changing their pouching system than were younger patients (OR = 7.193; 95% CI: 2.21-23.41; P = .001), as were those with diabetes mellitus (OR = 11.842; 95% CI: 2.56-54.77; P = .002).CONCLUSIONS:Patients undergoing ileostomy and those receiving postoperative chemotherapy are more likely to experience peristomal MASD. Older patients (>65 years) and those with diabetes mellitus are less likely to achieve independence. These findings influenced our management of persons undergoing ostomy surgery for management of colorectal cancer in our clinic. We recommend additional research using a larger and more diverse sample to confirm our findings.

Development and Validation of an Instrument Measuring Self-Care in Persons With a Fecal Ostomy.

The purpose of this study was to describe development of the Specific Self-Care for Ostomized Patients Questionnaire (CAESPO) instrument and evaluate its construct validity, internal reliability, and test-retest reliability (temporal stability). Prospective evaluation of psychometric properties of the instrument. The study sample comprised 125 persons (n = 89, 71.2% men) with a temporary (n = 42, 33.6%) and permanent (n = 83, 66.4%) colostomy (n = 102, 81.6%) and ileostomy (n = 23, 18.4%). Their mean age was 66.72 years; all had undergone ostomy surgery at least 3 months prior to study participation. Participants were drawn from 4 acute care facilities in the province of Castellon, Spain. The CAESPO Questionnaire is completed by a nurse or health care provider. It comprises 3 sections: the first queries sociodemographic data, the second queries pertinent clinical data, and the third contains 58 scored items with 4 ordinal responses. Possible cumulative scores ranged from 58 to 232 points; scores are reported based on a derived percentage score that varies from 0 to 100, where a score of 0 indicates lower self-care and 100 indicates a high level of self-care. Data were collected at baseline and retesting was completed 6 months later. Internal consistency of the CAESPO was evaluated using the Cronbach α coefficient; temporal stability (test-retest reliability) was evaluated using the test-retest procedure; confirmatory factor analysis based on conceptually hypothesized factor structure was performed to evaluate construct validity. Initial assessment of the construct validity of the CAESPO using confirmatory factory analysis revealed a poor fit, resulting in removal of multiple items from each of the subscales owing to low-factor loading values. The final model comprised 58 scored items; it was found to have a good fit based on standard indices (χ= 43.132, P < .001; root mean square error of approximation = 0.155 [0.107-0.204]; Bentler-Bonett normed fit index = 0.957; comparative fit index = 0.967; incremental fit index = 0.968), indicating adequate construct validity. The internal consistency of the CAESPO total score was acceptable at α = 0.889. Test-retest reliability (temporal stability) was deemed excellent (α = 0.987). Psychometric tests indicate that the CAESPO is a valid and reliable instrument for measuring self-care in persons living with a fecal ostomy.