Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool

BackgroundPeristomal skin complications (PSCs) are the most common post-operative complications following creation of a stoma. Living with a stoma is a challenge, not only for the patient and their carers, but also for society as a whole. Due to methodological problems of PSC assessment, the associated health-economic burden of medium to longterm complications has been poorly described.AimThe aim of the present study was to create a model to estimate treatment costs of PSCs using the standardized assessment Ostomy Skin Tool as a reference. The resultant model was applied to a real-life global data set of stoma patients (n = 3017) to determine the prevalence and financial burden of PSCs.MethodsEleven experienced stoma care nurses were interviewed to get a global understanding of a treatment algorithm that formed the basis of the cost analysis. The estimated costs were based on a seven week treatment period. PSC costs were estimated for five underlying diagnostic categories and three levels of severity. The estimated treatment costs of severe cases of PSCs were increased 2–5 fold for the different diagnostic categories of PSCs compared with mild cases. French unit costs were applied to the global data set.ResultsThe estimated total average cost for a seven week treatment period (including appliances and accessories) was 263€ for those with PSCs (n = 1742) compared to 215€ for those without PSCs (n = 1172). A co-variance analysis showed that leakage level had a significant impact on PSC cost from ‘rarely/never’ to ‘always/often’ p<0.00001 and from ‘rarely/never’ to ‘sometimes’ p = 0.0115.ConclusionPSCs are common and troublesome and the consequences are substantial, both for the patient and from a health economic viewpoint. PSCs should be diagnosed and treated at an early stage to prevent long term, debilitating and expensive complications.

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“…In Japan, this instrument has been implemented as a national standard tool. Recently the tool was validated and shown to be reliable [13], [14].…”

Section: Introductionmentioning

confidence: 99%

Peristomal Skin Complications Are Common, Expensive, and Difficult to Manage: A Population Based Cost Modeling Study

Lehur²,

et al. 2012

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“…1). This set of images was based on the Ostomy Skin Tool, which was tested in the ISI trial study group before the start of the trial14. The stoma therapists in all participating centres were trained to judge the severity of leakage with the aid of these pictures before the start of the study to achieve uniformity in scoring.…”

Section: Methodsmentioning

confidence: 99%

Randomized clinical trial of intracutaneouslyversustranscutaneously sutured ileostomy to prevent stoma-related complications (ISI trial)

Sier¹,

Wisselink²,

Ubbink³

et al. 2018

British Journal of Surgery

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BackgroundIleostomy construction is a common procedure but can be associated with morbidity. The stoma is commonly secured to the skin using transcutaneous sutures. It is hypothesized that intracutaneous sutures result in a tighter adherence of the peristomal skin to the stoma plate to prevent faecal leakage. The study aimed to compare the effect of intracutaneous versus transcutaneous suturing of ileostomies on faecal leakage and quality of life.MethodsThis randomized trial was undertaken in 11 hospitals in the Netherlands. Patients scheduled to receive an ileostomy for any reason were randomized to intracutaneous or transcutaneous suturing (IC and TC groups respectively). The primary outcome was faecal leakage. Secondary outcomes were stoma‐related quality of life and costs of stoma‐related materials and reinterventions.ResultsBetween April 2011 and February 2016, 339 patients were randomized to the IC (170) or TC (169) group. Leakage rates were higher in the IC than in the TC group (52·4 versus 41·4 per cent respectively; risk difference 11·0 (95 per cent c.i. 0·3 to 21·2) per cent). Skin irritation rates were high (78·2 versus 72·2 per cent), but did not differ significantly between the groups (risk difference 6·1 (95 per cent c.i. –3·2 to 15·10) per cent). There were no significant differences in quality of life or costs between the groups.ConclusionIntracutaneous suturing of an ileostomy is associated with more peristomal leakage than transcutaneous suturing. Overall stoma‐related complications did not differ between the two techniques. Registration number: NTR2369 ( http://www.trialregister.nl).

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“…Fear, pain, and nausea infl uence learning, and each must be addressed before effective learning can occur. 4,6,7,10,12 Literature search revealed several relevant educational plans including validated tools concerning skin problems 13 and scales to measure health-related quality of life after cystectomy. 7 , 10 The introduction of fast track pathways in clinical practice has reduced the length of postoperative hospitalization and opportunities for teaching while the patient remains in hospital signifi cantly.…”

Section: Validation Proceduresmentioning

confidence: 99%

The Urostomy Education Scale

Kristensen

Laustsen

Kiesbye

et al. 2013

Journal of Wound, Ostomy &Amp; Continence Nursing

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Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool

Abstract: The study supported the validity of the OST. It is suggested that a categorical scale can be used to illustrate the severity of the DET scores.

Cited by 81 publications

References 25 publications

Peristomal Skin Complications Are Common, Expensive, and Difficult to Manage: A Population Based Cost Modeling Study

Peristomal Skin Complications Are Common, Expensive, and Difficult to Manage: A Population Based Cost Modeling Study

Randomized clinical trial of intracutaneouslyversustranscutaneously sutured ileostomy to prevent stoma-related complications (ISI trial)

The Urostomy Education Scale

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