Complications After Ostomy Surgery: Emergencies and Obese Patients are at Risk—Data from the Berlin OStomy Study (BOSS)

Abstract

Background Complications are common after ostomy surgery. Data from the Berlin OStomy Study were evaluated to determine risk factors for complications. Patients and methods Patients with a bowel ostomy were questioned using a questionnaire concerning patients’ characteristics and history as well as the ostomy and its complications. The questionnaire also contained a nine‐fielded abdominal sketch to determine the exact ostomy location. Results Over 42 months, 2647 patients completed the questionnaire. Obese patients and patients after emergency surgery were more prone to ostomy‐related complications. This result was independent of the kind of ostomy (small bowel ostomy or colostomy) and of the abdominal location. The overall ostomy complication rate was 55.6%. Conclusion Significantly more complications were recorded after emergency surgery and in obese patients than after elective surgery and in non‐obese patients, respectively. There was no preferential abdominal location for avoiding general ostomy complications. The results emphasized the importance of preoperative ostomy site marking by qualified personnel such as ostomy nurses or surgeons to reduce complication rates by respecting individual abdominal configurations. With an increasing prevalence of obesity, ostomy surgery will become even more challenging in the future. A division of the abdominal wall into nine regions might be helpful and more precise for describing and examining ostomy‐related complications in the future.

Intestinal Ostomies Created During Emergency Surgery Possess Unique Challenges

“…A recent German observational study shows similar results. Braumann et al report that a total of 61% of patients with emergency ostomies had ostomy-related complications, whereas only 52% of patients with elective ostomies had complications (8). Peristomal skin irritations and ostomy retractions were more common and more severe in the emergency ostomy group.…”

Conservative Management of Necrotic Colostomy in a Fragile Patient Under Palliative Chemotherapy

“…These situations difficult the organism to carry out cell regeneration and proper tissue healing [6]. Furthermore, it is known that an ostomy created during an emergent surgery considerably increases the risk of presenting related complications [7].…”

Preoperative stoma site marking for fecal diversions (ileostomy and colostomy): position statement of the Canadian Society of Colon and Rectal Surgeons and Nurses Specialized in Wound, Ostomy and Continence Canada

“… 5 , 6 Obesity, emergency surgery, diabetes and preoperative stoma site marking have been shown to have the most important impact on ostomy complication rates. 7 , 8 Proper education of health care providers is critical in ensuring that the stoma is well positioned. Although stoma marking is most often performed by certified ostomy nurses, nurses specialized in wound, ostomy and continence (NSWOC) may not always be readily available.…”

“… 12 Preoperative stoma site marking should be mandatory in elective cases and should also be performed for emergency procedures and, as far as possible, within the emergency setting. 7 , 13 , 14 …”