Complication Rates of Ostomy Surgery Are High and Vary Significantly Between Hospitals

Abstract

Structured Abstract Background Ostomy surgery is common and has traditionally been associated with high rates of morbidity and mortality, suggesting an important target for quality improvement. Objective To evaluate the variation in outcomes after ostomy creation surgery within Michigan in order to identify targets for quality improvement. Design Retrospective cohort study. Setting The 34-hospital Michigan Surgical Quality Collaborative (MSQC). Patients Patients undergoing ostomy creation surgery between 2006-2011. Main outcome measures We evaluated hospitals' morbidity and mortality rates after risk-adjustment (age, comorbidities, emergency v. elective, procedure type). Results 4,250 patients underwent ostomy creation surgery; 3,866 (91.0%) procedures were open and 384 (9.0%) were laparoscopic. Unadjusted morbidity and mortality rates were 43.9% and 10.7%, respectively. Unadjusted morbidity rates for specific procedures ranged from 32.7% for ostomy-creation-only procedures to 47.8% for Hartmann's procedures. Risk-adjusted morbidity rates varied significantly between hospitals, ranging from 31.2% (95%CI 18.4-43.9) to 60.8% (95%CI 48.9-72.6). There were five statistically-significant high-outlier hospitals and three statistically-significant low-outlier hospitals for risk-adjusted morbidity. The pattern of complication types was similar between high- and low-outlier hospitals. Case volume, operative duration, and use of laparoscopic surgery did not explain the variation in morbidity rates across hospitals. Conclusions Morbidity and mortality rates for modern ostomy surgery are high. While this type of surgery has received little attention in healthcare policy, these data reveal that it is both common and uncommonly morbid. Variation in hospital performance provides an opportunity to identify quality improvement practices that could be disseminated among hospitals.

Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: A prospective, randomized, multicenter trial

“…These findings are comparable with other studies investigating the morbidity and mortality rates of diverting stomas. [16][17][18][19][20][21] Additionally, several risk factors leading to a permanent stoma in initially defunctioned patients after rectal resection must be considered. 35,36 In our series, only 2 patients were not reversed at the time of analysis.…”

“…Moreover, stoma reversal also implies a secondary hospital stay and several temporary stomas become permanent. 20,21 Another technique reported to reduce possibly leakage rates is to perform a colonic J-pouch for reconstruction in low anastomoses. 12,13 A pouch may improve leakage rates most likely owing to an improved blood supply to the apex of the pouch 22 and may help to avoid a protective stoma.…”

Clinical Practice Guidelines for Ostomy Surgery

“…one recent population-based study based on national surgical Quality improvement Program data showed a 37% unadjusted complication rate for elective cases involving an ostomy, and 55% for emergency operations. 2 furthermore, risk-adjusted morbidity rates varied significantly among hospitals, indicating the potential to improve outcomes. 2 however, the true morbidity of ostomy surgery includes significant negative effects on quality of life, plus longer-term morbidity related to ostomy care.…”

“…2 furthermore, risk-adjusted morbidity rates varied significantly among hospitals, indicating the potential to improve outcomes. 2 however, the true morbidity of ostomy surgery includes significant negative effects on quality of life, plus longer-term morbidity related to ostomy care. [3][4][5][6][7][8][9][10] up to half of ostomies are "problematic," presenting management problems including skin irritation and pouching difficulties that require prolonged medical care and result in increased health care costs (prolonged length of stay and/ or increased need for outpatient care).…”

The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization

“… 6 A majority of these individuals experience life adjustment difficulties 7 and postoperative complications. 8 Such postoperative complications often lead to unexpected hospital readmissions 9 and may also result in emergency room (ER) visits. According to US hospital readmission statistics from the Healthcare Cost and Utilization Project (HCUP), 10 ileostomies and other fecal ostomies had the second highest 30-day readmission rates.…”