Stoma-Related Complications Following Ostomy Surgery in 3 Acute Care Hospitals

Abstract

PURPOSE: The aim of this study was to evaluate both surgical and patient-centered stomal complications after stoma formation, with emphasis on underreported symptoms and complaints. DESIGN: Prospective, single-group study. SUBJECTS AND SETTING: Patients undergoing emergency and elective ostomy surgery between January 1, 1999, and June 1, 2016, in 3 acute care hospitals were followed up by stoma care nurse specialists in NHS Lanarkshire, Scotland. METHODS: Data were collected on surgery type (emergency or elective), stoma type (ileostomy or colostomy), stoma-related complications including surgical complications (stenosis, retractions, hernia, and prolapse) and so-called “patient-centered” complications (skin changes, odor, leakage, soiling, and nighttime emptying) at 5 time points: 10 days, 3 months, 6 months, 1 year, and 2 years postoperatively. For this study, we report comparisons at 10 days and 2 years, using frequencies reported as percentages. RESULTS: Data from 3509 consecutive stoma surgeries were analyzed. Complication rates were similar in both emergency and elective cases. The nighttime symptoms of leakage and soiling were significantly greater in the ileostomy group and worsened over the 2-year period. The parastomal hernia rate was 34.5% at 2 years, a finding more common in the colostomy group (46.4% vs 20.1%, P < .001). However, the rate of clinically significant hernia was similar when comparing the colostomy group with the ileostomy group (3.6% vs 2.2%, P = .38). Emergency stoma surgeries (40.2%) were preoperatively sited compared with 95.9% of elective cases. CONCLUSIONS: Our prospective multicenter study demonstrated that stoma-related complications are similar irrespective of whether the stoma was formed via an elective surgery or emergency surgery. Nighttime symptoms of leakage, soiling, and emptying were high post–stoma formation, particularly in the ileostomy group, and worsened over the 2-year period. Findings from our study highlight the presence and persistence of complications. We believe our work highlights the importance of having frequent discussions with patients about making decisions about approaches to reduce complications to enhance patient outcomes.

Life with a stoma across five European countries—a cross-sectional study on long-term rectal cancer survivors

“…Impairments of health-related quality of life (HRQoL) [7,8] are also reported but may differ [9] due to the diverse social and health care situations across countries [10]. A growing body of literature has documented the occurrence of a range of stoma-related complications within the early years of stoma formation [11,12]. Stenosis, parastomal hernia, and stomal prolapse are examples of frequently reported complications [11,[13][14][15].…”

Stoma-related complications and emergencies

“…Stoma-related complications are common and can be classified as early or late. The rates of stoma complications reported in the literature vary widely, ranging from 10 to 70% [ 7 , 9 , 10 ]. The risk for complications from stoma creation is lifelong, although complications have been reported to be most frequent in the first 5 years postoperatively [ 7 , 9 ].…”

“…Common early complications include leakage and skin irritations, high output resulting in fluid and electrolyte imbalances, or stoma necrosis; late complications include parastomal hernia, stoma prolapse, and stoma stenosis [ 7 ]. These can develop as a result of surgical- or patient-related factors (Table 2 ) [ 2 , 10 – 12 ].…”

Stomas

“…A parastomal hernia occurs when there is a protrusion of bowel contents through the fascial defect in the abdominal wall. They are extremely common and a recent study has demonstrated a parastomal hernia rate of 34.5% at 2 years (Pearson et al., 2020). Patients will usually present with a bulge around their stoma site.…”