Predictors of complications from stoma closure in elective colorectal surgery: an assessment from the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP)

Abstract

Background There is significant morbidity after diverting ileostomy closure, so identifying predictors of complications could be of great benefit. The aim of our study was to evaluate the incidence and risk factors for postoperative morbidity after elective ileostomy closure. Methods The ACS-NSQIP dataset was evaluated for elective ileostomy closures from 1/1/2015 to 12/31/2016. Demographic characteristics, operative, and postoperative outcomes were evaluated. The primary outcome was 30-day major morbidity (Clavien class III and greater). Secondary outcomes were rates and predictors of major morbidity, superficial site infection (SSI), reoperation, and readmission from multivariate logistic regression modeling. Results We retrospectively evaluated 1885 patients. The median operative time was 65 (IQR 50–90) minutes and median length of stay was 3 (IQR 2–5) days. Major morbidity was recorded in 6.7%, including mortality (1.0%), deep/organ space SSI (2.6%), dehiscence (0.8%), reintubation (0.5%), sepsis (1.7%), septic shock (0.8%), and reoperation (3.7%). Readmission was recorded in 9.7% and 6.2% had SSI. Multivariate logistic regression showed male sex (OR 1.584; 95% CI 1.068–2.347; p = 0.022) and longer operative time (OR 1.004; 95% CI 1.001–1.007; p = 0.009) were among those variables associated with increased odds of major morbidity. Dyspnea (OR 2.431; 95% CI 1.139–5.094; p = 0.021) and longer operative time (OR 1.003; 95% CI 1.001–1.007; p = 0.034) were among the independent risk factors for SSI. Male sex (OR 2.246; 95% CI 1.297–3.892; p = 0.004, chronic obstructive pulmonary disease (OR 2.959; 95% CI 1.153–7.591; p = 0.024), and longer operative time (OR 1.005; 95% CI 1.001–1.009; p = 0.011) were associated with increased odds of reoperation. Chronic obstructive pulmonary disease (OR 2.578; 95% CI 1.338–4.968; p = 0.005), wound infection (OR 2.680; 95% CI 1.043–6.890; p = 0.041), and inflammatory bowel disease (OR 2.565; 95% CI 1.203–5.463; p = 0.015) were associated with increased odds of readmission. Conclusions Elective stoma closure has significant risk of morbidity. Patients with longer operative times were at increased risk for major morbidity, overall SSI, and reoperation. From the analysis, factors specifically associated with major morbidity, overall infectious complications, readmissions, and reoperations were identified. This information can be used to prospectively prepare for these high-risk patients, potentially improving postoperative outcomes. Electronic supplementary material The online version of this article (10.1007/s10151-020-02307-5) contains supplementary material, which is available to autho...

Outcomes of diverting loop ileostomy reversal in the elderly: a case–control study

“…Post‐operative LOS and re‐admission rates were also similar between the two groups. Our overall complications and severe complication rate of 6.5% are in concordance with previously published data 18,19 . Multivariate analysis did not find age to be a risk factor for severe post‐operative complications.…”

“…However, their cohort included colostomy closures together with ileostomy closures. An analysis of 1885 patients based on the American College of Surgeons National Surgical Quality Improvement Program database found male gender and longer operative time to be associated with increased major morbidity 19 . Indeed, prolonged operative time may be a surrogate for patient factors (such as obesity or frailty), increased case complexity, intraoperative events or surgeon experience.…”

“…reported an overall complication rate of 32%, with a 7.2% major complications rate and a 0.2% mortality rate 18 . In a national review of 1885 DLI reversals, there were 20.3% overall complications, 6.7% major complications and 1% mortality rate 19 . In addition, the procedure is usually associated with substantial LOS and readmission rates.…”

Association of Risk Factors for the Mortality and Morbidity of Stoma Closure

“…A multi-regression study stated that male sex and operating times are two main risk factors for increasing morbidity/mortality in stoma closure patients. 15 The time of surgery was documented as crucial in the present study findings as well as in other literature. 15,16 Late closure of stoma has been related with stoma complications prolapse, hernia, peristomal fistula or dermatitis and retraction.…”

“…15 The time of surgery was documented as crucial in the present study findings as well as in other literature. 15,16 Late closure of stoma has been related with stoma complications prolapse, hernia, peristomal fistula or dermatitis and retraction. 17 The ASA score is also an important factor in causing increased risk of mortality in stoma closure patients.…”