The effect of preoperative stoma site marking on risk of stoma‐related complications in patients with intestinal ostomy — A systematic review and meta‐analysis

Abstract

Aim This systematic review and meta‐analysis aimed to investigate the effect of preoperative stoma site marking on stoma‐related complications in patients with intestinal ostomy. Methods MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient‐relevant outcome. Outcomes were prioritised by stakeholder involvement. Random‐effects meta‐analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS‐I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. Results This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma‐related complications (OR: 0.45, 95% CI: [0.31–0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health‐related quality of life (SMD: 1.13 [0.38–1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06–0.37]) and may decrease dermatological complications (OR: 0.38 [0.29–0.50]) and surgical revision (OR: 0.09 [0.02–0.49]). The confidence in the cumulative evidence was moderate to very low. Conclusion Despite low quality evidence, preoperative stoma site marking can prevent stoma‐related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.

Preoperative stoma site marking reduces postoperative stoma-related complications in emergency surgery: A single center retrospective cohort study

“…However, these studies generally investigated stoma complication risk factors using elective surgery cohorts or combined cohorts of elective with emergency surgeries. [5][6][7][8][9][10]13,20,21 The clinical significance of stoma site marking specifically in emergency stoma creation was not extensively addressed as only a small population received stoma marking prior to emergency surgery. The effects of preoperative stoma site marking on postoperative complications were investigated by analyzing exclusively patients who received urgent ostomy formation.…”

“…[5][6][7][8]11,12 A recent meta-analysis also showed that stoma site marking might reduce the risk of stoma-related complications. 13 Intensive interdisciplinary care before emergency surgery is essential to provide optimal care for stoma patients. However, due to limited time and staff, stoma site marking may not be routinely performed before emergency surgery.…”

Preoperative Optimization of Crohn's Patients before Abdominopelvic Surgery

“…A meta-analysis performed showed that preoperative stoma marking can also decrease the risk of stoma-related complications. 53…”

The impact of intestinal stoma formation on patient quality of life after emergency surgery—A systematic review

“…Several potential factors have been identified which may improve the patient experience after stoma formation in the elective setting across the perioperative journey. Preoperative stoma marking can reduce the risk of stoma‐related complications and has been shown to improve HR‐QoL [11]. Specific perioperative techniques, such as optimal stoma creation with minimal tension or a laparoscopic approach, may minimize perioperative complications [2].…”