Factors Influencing Morbidity and Mortality of Elective Stoma Closure

Abstract

Background: Stoma are often created in the emergency. These patients usually undergo restoration of bowel continuity electively 10 to 12 weeks later. Material and Methods: Patients undergoing elective stoma closure were followed up for 3 months post-operatively for any morbidity (or mortality). Various patient and surgeon variables were analyzed to define factors that could affect the outcome of bowel restoration. Results: Of the 80 patients included, 62 were male (77.5%) and 18 (22.5%) female with an average age of 37.8 years. The commonest indication of stoma creation was peritonitis (52.5%); all patients underwent restoration after an average duration of 161.1 days. 47 patients (58.8%) developed 62 morbidity events-commonly, wound infection (47.5%), anastomotic leak (15%) and early post-operative ileus (6.25%). There were 4 deaths (5%). Univariate analysis revealed significantly higher rate of anastomotic leakin patients with low BMI, low hemoglobin, low albumin, laparotomy for restoration, and American Society of Anesthesiology (ASA) grade III.-Post-operative obstruction was significantly associated with delay in closure, laparotomy, ASA grade III , and when consultants performed restoration. Mortality was significantly higher in patients with age above 55 years, low BMI, ASA grade III, low pre-operative hemoglobin and after anastomotic leak. Conclusion: Restoration is not an innocuous procedure; significant morbidity and mortality is associated with it. Proper timing of closure as well as optimizing the patient help in reducing the morbidity and mortality of the operation.