Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery

Abstract

PURPOSE:Ostomy creation is often an integral part of the surgical management of various diseases including colorectal malignancies and inflammatory bowel disease. Stoma and peristomal complications may occur in up to 70% of patients following ostomy surgery. The aim of this scoping literature review was to synthesize evidence on the risk factors for developing complications following creation of a fecal ostomy. DESIGN: Scoping literature review. SEARCH STRATEGY: Two independent researchers completed a search of the online bibliographic databases PubMed, MEDLINE, Cochrane, Google Scholar, and EMBASE for all articles published between January 1980 and December 2018. The search comprised multiple elements including systematic literature reviews with meta-analysis of pooled findings, randomized controlled trials, cohort studies, observational studies, other types of review articles, and multiple case reports. We screened 307 unique titles and abstracts; 68 articles met our eligibility criteria for inclusion. The methodological rigor of study quality included in our scoping review was variable. FINDINGS/CONCLUSIONS: We identified 6 risk factors associated with an increased likelihood of stoma or peristomal complications (1) age more than 65 years; (2) female sex; (3) body mass index more than 25; (4) diabetes mellitus as a comorbid condition; (5) abdominal malignancy as the underlying reason for ostomy surgery; and (6) lack of preoperative stoma site marking and WOC/ostomy nurse specialist care prior to stoma surgery. We also found evidence that persons with a colostomy are at a higher risk for prolapse and parastomal hernia. IMPLICATIONS: Health care professionals should consider these risk factors when caring for patients undergoing fecal ostomy surgery and manage modifiable factors whenever possible. For example, preoperative stoma site marking by an ostomy nurse or surgeon familiar with this task, along with careful perioperative ostomy care and education of the patient by an ostomy nurse specialist, are essential to reduce the risk of modifiable risk factors related to creation of a fecal ostomy.

Stoma-Related Complications: A Single-Center Experience and Literature Review

“…A review reported by Zelga et al found that age over 65 years, female sex, BMI higher than 25 kg/m 2 , diabetes mellitus, abdominal malignancy, and lack of perioperative stoma site marking are risk factors associated with increased likelihood of stoma-related complications. 46 Our results showed a mean age of 64.5 years and the presence of diabetes in 18.4% of cases.…”

Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese

“…Findings from multiple studies also suggest that patients living with an ostomy are more likely to experience peristomal irritant contact dermatitis due to exposure of the skin to fecal effluent. 42,46,53 Significant differences were not found when the OST score was analyzed based on time since ostomy surgery, preoperative stoma site marking, and presence of a retracted ostomy. Considered collectively, these do not allow firm conclusions concerning the discriminant validity of the adapted OST.…”

CE: Caring for Patients After Ileostomy Surgery

“…A scoping literature review by Zelga and colleagues found that diabetes is one of five independent risk factors associated with an increased risk of stomal or peristomal complications. 24 Patients who have this disease need special instructions about appropriate dietary intake while maintaining adequate blood glucose control. The optimal diet is achieved through a combination of education, monitoring and revising care plans, and individualizing the plan to specific told to expect some cramping and discomfort during digital manipulation.…”