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Merritt C, Maldonado P. Management of the Difficult Stoma. Surg Clin North Am 2024; 104:579-593. [PMID: 38677822 DOI: 10.1016/j.suc.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Fecal ostomy creation is a commonly performed procedure with many indications. Better outcomes occur when preoperative patient education and stoma site marking are provided. Despite a seemingly simple operation, ostomy creation is often difficult and complications are common. Certain risk factors, particularly obesity, are strongly associated with stoma-related complications. The ability to optimize the ostomy and stoma in the operating room and to troubleshoot frequently encountered post-operative stoma-related issues are critical skills for surgeons and ostomy nurses alike.
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Affiliation(s)
- Clay Merritt
- Department of Colon and Rectal Surgery, Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Sunrise Pavilion, 2nd Floor, General Surgery Reception Desk, Fort Belvoir, VA 22060, USA.
| | - Paola Maldonado
- Wound Care Clinic, Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Sunrise Pavilion, 2nd Floor, General Surgery Reception Desk, Fort Belvoir, VA 22060, USA
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Guler S, Eyuboglu G, Baykara ZG, Hin AO, Akdemir H, Akar E, Leventoglu S, Yuksel O. The Effect of Stoma Site Marking on Stomal Complications: A Long-term Retrospective Study. Adv Skin Wound Care 2024; 37:254-259. [PMID: 38648238 DOI: 10.1097/asw.0000000000000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To identify the effect of stoma site marking on stoma-related complications. METHODS The study sample included 639 individuals with stomas who were followed up in a stomatherapy unit in Turkey between January 1, 2017, and June 20, 2021. Researchers collected patient data from nursing records. Data were evaluated using number, percentage, χ2, and logistic regression tests. RESULTS Of the individuals with stomas, 60.6% (n = 387) were men, and 72.6% (n = 464) had a cancer diagnosis. Their mean age was 60.16 (SD, 14.81) years. The stoma site was marked preoperatively in of 67.1% of patients (n = 429), and 17.1% (n = 109) developed stoma-related complications. The complication rate was higher in individuals with unmarked stoma sites (25.7%; P = .000), emergency surgeries (25.0%; P = .006), colostomies (23.9%; P = .042), and permanent stomas (28.3%; P = .002). The three most common complications were peristomal skin problems (56.9%), mucocutaneous separation (13.8%), and edema (9.2%). CONCLUSIONS The incidence of stoma-related complications in the postoperative period was higher in individuals with unmarked stoma sites. The authors recommend that stoma and wound care nurses mark the stoma site in individuals for whom stoma creation is planned.
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Affiliation(s)
- Sevil Guler
- Sevil Guler, PhD, RN, is Professor, Faculty of Nursing, Department of Surgical Nursing, Gazi University, Ankara, Turkey. Gulcan Eyuboglu, PhD, RN, is Research Assistant, Erbaa Faculty of Health Science, Department of Nursing, Fundamentals of Nursing, Gaziosmanpasa University, Tokat, Turkey. Also at Gazi University, Faculty of Nursing, Department of Fundamentals of Nursing, Zehra Gocmen Baykara, PhD, RN, is Professor. At Gazi University Health Research and Application Center Hospital, Stomatherapy Unit, Aysel Oren Hin, RN; Hülya Akdemir, RN; and Emine Akar, RN, are Stoma and Wound Care Nurses. Also at Gazi University, Sezai Leventoglu, MD, and Osman Yuksel, MD, are Professors, Faculty of Medicine, Department of General Surgery. The authors have disclosed no financial relationships related to this article. Submitted January 5, 2023; accepted in revised form March 14, 2023
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MacDonald S, Wong LS, Ng HJ, Hastings C, Ross I, Quasim T, Moug S. Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery - a multicentre retrospective study. Colorectal Dis 2024; 26:994-1003. [PMID: 38499914 DOI: 10.1111/codi.16947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/20/2024]
Abstract
AIM Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma-related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse. There is a paucity of research on specific risk factors within the emergency cohort for development of SRCs. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs within this cohort. METHOD Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3-year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs. RESULTS A total of 455 patients were included (median follow-up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24-5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35-0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92-5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01-8.69), p < 0.001] were risk factors for late SRCs. CONCLUSION Stoma-related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting.
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Affiliation(s)
- Scott MacDonald
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Li-Siang Wong
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Hwei Jene Ng
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Claire Hastings
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Immogen Ross
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Tara Quasim
- Department of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Susan Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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Ayik C, Bişgin T, Cenan D, Manoğlu B, Özden D, Sökmen S. Risk factors for early ostomy complications in emergency and elective colorectal surgery: A single-center retrospective cohort study. Scand J Surg 2024; 113:50-59. [PMID: 38041524 DOI: 10.1177/14574969231190291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND AND AIMS The clinical significance of early ostomy complications has been emphasized worldwide, and the current evidence concerning the impact of emergency or elective surgery on ostomy complications is limited. This study aimed to investigate the effect of elective and emergency colorectal surgery on early ostomy complications and the risk factors associated with specific complications. METHODS A mandatory colorectal recording system for consecutive ostomy patients between 2012 and 2020 was reviewed retrospectively. Patient socio-demographics, ostomy-related variables, and early period ostomy complications were retrieved from the patient records. The chi-square test, t-test, analysis of variance (ANOVA), and logistic regression were used to analyze the data. RESULTS The study cohort included 872 patients. At least one or more complications developed in 573 (65.7%) patients, 356 (63.6%) in the emergency group, and 217 (69.6%) in the elective group. When comparing emergency surgery to elective surgery, necrosis (7.4% versus 3.4%, p = 0.009), mucocutaneous separation (37.2% versus 27.1%, p = 0.002), and bleeding (6.1% versus 2.1%, p = 0.003) were more prevalent. Peristomal irritant contact dermatitis (PICD) (37.3% versus 26%, p < 0.001) was more common in elective surgery. Risk factors for PICD were comorbidity (p = 0.003), malignant disease (p = 0.047), and loop ostomy (p < 0.001) in elective surgery; female sex (p = 0.025), neo-adjuvant therapy (p = 0.024), and ileostomy (p = 0.006) in emergency surgery. The height of the ostomy (less than 10 mm) was a modifiable risk factor for mucocutaneous separation in both elective surgery (p < 0.001) and emergency surgery (p = 0.045). CONCLUSION Early ostomy complications were more likely to occur after emergency colorectal surgery than in an elective setting. Patient- and ostomy-related risk factors for complications differed between elective and emergency surgeries.
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Affiliation(s)
- Cahide Ayik
- Assistant Professor, Faculty of Nursing, Dokuz Eylul University, Izmir 35330, Turkey
| | - Tayfun Bişgin
- Department of General Surgery, Dokuz Eylul University, Turkey
| | - Deniz Cenan
- Dokuz Eylul University Hospital, Izmir, Turkey
| | - Berk Manoğlu
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Özden
- Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Selman Sökmen
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
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Nozawa H, Sasaki S, Hayashi C, Kawasaki A, Sasaki K, Murono K, Emoto S, Ishihara S. Preoperative stoma site marking reduces postoperative stoma-related complications in emergency surgery: A single center retrospective cohort study. Scand J Surg 2024; 113:40-49. [PMID: 37462098 DOI: 10.1177/14574969231186282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Stoma site marking is an important factor in reducing stoma-related complications, thereby influencing the long-term quality of life in the elective setting. The impact of preoperative stoma site marking in emergency stoma creation is largely unknown. We aimed to determine whether preoperative stoma site marking in emergency stoma creation reduces stoma-related complications. METHODS Patients who underwent emergency stoma creation at our hospital between 2009 and 2022 were examined by reviewing our prospective database and retrospective chart review. Subjects were classified into the "marking (+)" or "marking (-)" group according to stoma site marking (194 and 151 patients, respectively). The changes in the frequency of stoma marking over time and the effects of stoma marking on stoma-related complications were analyzed. RESULTS The overall frequency of grade 2 or higher stoma-related complications was lower in the marking (+) group than in the marking (-) group (24% versus 36%, p = 0.010). Stoma site marking was associated with fewer soma site bleeding (2% versus 10%, p < 0.001), and the frequency of peristomal dermatitis was also lower (10%) in the marking (+) group (versus 18%, p = 0.042). Moreover, the lack of stoma site marking was an independent risk factor for overall stoma-related complications (adjusted odds ratio: 1.69, p = 0.034). CONCLUSIONS Preoperative stoma site marking was associated with stoma-related complications in emergency surgery. The clinical significance of our attempt is worth validating with prospective studies.
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Affiliation(s)
- Hiroaki Nozawa
- Department of Surgical Oncology
- The University of Tokyo 7-3-1 Hongo, Bunkyo-ku Tokyo 113-8655 Japan
| | - Sanae Sasaki
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Chieko Hayashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Akiko Kawasaki
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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Chery MJ, Henderson R, Dubique K, Camilus A, Eliacin HC, Pinard J, Toussaint E, Clisbee M. "I Am Half of a Person": Lived Experiences of Individuals Living With Ostomy After Surgery in Rural Haiti. QUALITATIVE HEALTH RESEARCH 2024:10497323241229420. [PMID: 38332547 DOI: 10.1177/10497323241229420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Intestinal ostomy can have significant effects on lives and lived experiences. However, limited research exists on the experiences of persons with ostomy in low-resource settings, such as rural Haiti. This study aimed to explore the lived experiences of Haitians with an ostomy, focusing on the physical, psychological, and social aspects of their post-operative lives. We conducted 9 semi-structured, in-depth interviews with participants who had undergone ostomy surgery at the Hôpital Universitaire de Mirebalais in Haiti. Employing interpretative phenomenological analysis (IPA), we iteratively examined transcripts to identify convergent and divergent codes, which were then grouped into themes to better understand the participants' experiences. Three themes emerged: (a) ostomy as a social disease, which has severe impacts on relationships and place in society; (b) ostomy as altering self-image, leading participants to reflect on their identity and the underlying causes of their condition and to reevaluate their necessities and abilities; and (c) ostomy as an arduous medical journey, characterized by pain, distress, uncertainty, and disillusionment, but also resiliency, improvisation, and hope. This study highlights the multifaceted experiences of persons with ostomy in the low-resource rural environment of Haiti and underscores the need for improved access to medical care, financial support, and psychosocial and caregiving resources for these individuals. Findings also emphasize the importance of medical providers' improved understanding in making medical decisions, and cultural and socioeconomic factors in developing effective support strategies.
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Affiliation(s)
- Maurice J Chery
- Research Department, Zanmi Lasante/Partners in Health Mirebalais, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Rebecca Henderson
- Research Department, Zanmi Lasante/Partners in Health Mirebalais, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kobel Dubique
- Research Department, Zanmi Lasante/Partners in Health Mirebalais, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Adler Camilus
- Research Department, Zanmi Lasante/Partners in Health Mirebalais, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Henry Claude Eliacin
- Surgery Department Zanmi Lasante/Partners in Health Mirebalais, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Jacquemine Pinard
- Surgery Department Zanmi Lasante/Partners in Health Mirebalais, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Eric Toussaint
- Surgery Department Zanmi Lasante/Partners in Health Mirebalais, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Mary Clisbee
- Research Department, Zanmi Lasante/Partners in Health Mirebalais, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
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Martín-Gil B, Rivas-González N, Santos-Boya T, López M, Jiménez JM, Redondo-Pérez N, Del Río-García I, Berdón-Berdón M, Fernández-Castro M. Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme. Int Wound J 2023; 21:e14456. [PMID: 37963817 PMCID: PMC10898385 DOI: 10.1111/iwj.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.
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Affiliation(s)
- Belén Martín-Gil
- Department of Nursing Care Information Systems, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Noel Rivas-González
- Continual Trainig Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María López
- Nursing Faculty, University of Valladolid, Valladolid, Spain
| | | | - Natán Redondo-Pérez
- Nursing Direction, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Berdón-Berdón
- Nursing Direction, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Chan MS, Moore Z, Patton D, McNamara D, O'Connor T, Avsar P. A systematic review of patient risk factors for complications following stoma formation among adults undergoing colorectal surgery. Int J Colorectal Dis 2023; 38:238. [PMID: 37747515 DOI: 10.1007/s00384-023-04523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Stoma formation is a commonly performed procedure both during and following colorectal surgery. When designed correctly, stomas can dramatically improve patients' quality of life, but the reverse may occur when complications arise. Given the significant negative impact of complications following stoma formation, understanding risk factors that may be mitigated pre-operatively is important. METHOD A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in May 2022. Data was extracted and a narrative synthesis undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the included studies. The systematic review includes various research designs such as randomised controlled trials (RCT), case-control studies, and observational cohort studies written in English. Reviews, conference papers, opinion papers, and those including participants < 18 years old were excluded. No restrictions on the date of publication and study setting were applied. RESULTS This review included 17 studies, conducted between 2001 and 2020. The study designs were prospective audit, prospective analysis, retrospective analysis, longitudinal analysis and multivariate analysis of self-reported questionaires/surveys. Twenty-two possible risk factors for the development of stoma complications following stoma formation were identified. These include demographical risk factors, underlying medical condition, type of surgery, elective vs emergency surgery, stoma factors, surgical factors, indications for surgery and factors which may impact healing. Furthermore, high BMI, emergency surgery, and stoma type were identified as the most frequently occurring risk factors. CONCLUSION Given the large number of risk factors identified, the implementation of a risk stratification tool may decrease the incidence and prevalence of stoma complication development. This, in turn, would decrease the associated healthcare-related costs, and negative impact on mortality, length of stay and quality of life.
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Affiliation(s)
- Mai Shanley Chan
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash, Australia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Lida Institute, Shanghai, China
- University of Wales, Cardiff, UK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith, QLD, Australia
| | - Declan Patton
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Deborah McNamara
- Beaumont Hospital, Dublin, Ireland
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Lida Institute, Shanghai, China
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Rolls N, Gotfredsen JL, Vestergaard M, Hansen AS, Koblauch H. Importance of stoma care nurses in preparing patients for stoma surgery and adjustment to life with a stoma. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S32-S41. [PMID: 37682765 DOI: 10.12968/bjon.2023.32.16.s32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Stoma surgery is a life-changing event and patients must subsequently make significant adjustments to their lives. AIM The study set out to understand the level of interaction between patients and stoma care nurses (SCNs) in relation to preparing patients for stoma surgery and in adjustment to life with a stoma. METHODS Retrospective, self-reported questionnaires for patients and SCNs. FINDINGS Most patients (98%) with planned stoma surgery had pre-operative consultations with health professionals in contrast to 36% of patients with unplanned surgery, who did not. One third of patients with unplanned surgery did not feel prepared for life with a stoma based on the information provided during their hospital stay. Two thirds of the nurses reported having sufficient time to prepare patients for stoma surgery and to life with a stoma. CONCLUSION SCNs are key in preparing patients for surgery and for life with a stoma. Variations in care were experienced by patients having planned versus unplanned surgeries.
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Affiliation(s)
- Natasha Rolls
- Lead Stoma Care Nurse, University Hospitals Bristol and Weston NHS Foundation Trust
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Manole TE, Daniel I, Alexandra B, Dan PN, Andronic O. Risk Factors for the Development of Parastomal Hernia: A Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:187-192. [PMID: 37533654 PMCID: PMC10393091 DOI: 10.4103/sjmms.sjmms_235_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.
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Affiliation(s)
- Teodora Elena Manole
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ion Daniel
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Bolocan Alexandra
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Păduraru N. Dan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Octavian Andronic
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
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Cox J, Isip R, Reid M, Hulme D, Marra A. Predictors of Hospital Readmission in Patients Undergoing Creation of an Intestinal Ostomy. J Wound Ostomy Continence Nurs 2023; 50:215-221. [PMID: 37146112 DOI: 10.1097/won.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The purpose of this study was to identify predictors of 30- and 60-day hospital readmission in patients undergoing ileostomy or colostomy creation. DESIGN A retrospective, cohort study. SAMPLE AND SETTING The study sample comprised 258 patients who underwent ileostomy or colostomy creation from 2018 to 2021 in a suburban teaching hospital in the northeastern United States. The mean age of participants was 62.8 (SD 15.8) years; half were female and half were male. Slightly more than half 50.3% (n = 130) and 49.2% (n =127) underwent ileostomy surgery. METHODS Data were abstracted from the electronic medical record and included the following variable categories: demographic factors, ostomy- and surgical-related factors, and ostomy- and surgical-related complications. Study outcome measures were readmission within 30 and 60 days from the index hospital admission discharge date. Predictors of hospital readmission were analyzed using bivariate testing, followed by multivariate analysis. RESULTS Within 30 days of the index hospitalization, 49 patients were readmitted (19%), and 17 patients were readmitted (6.6%) within 60 days. For readmissions within 30 days, anatomical location of the stoma in the ileum and transverse colon as compared to descending/sigmoid colon stomas emerged as significant predictors (odds ratio [OR] 2.2; P = .036; confidence interval [CI] 1.05-4.85; OR 4.5; P = .036; CI 1.17-18.53, respectively). Within 60 days, length of the index hospitalization from 15 to 21 days as compared to shorter lengths of hospitalization emerged as the only significant predictor at this timeframe (OR 6.62; P = .018, CI 1.37-31.84). CONCLUSIONS These factors provide a basis for identifying patients at higher risk for hospital readmission following ileostomy or colostomy surgery. For patients at higher risk for readmission following ostomy surgery, heightened surveillance and management in the immediate postoperative period may be necessary to avert potential complications.
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Affiliation(s)
- Jill Cox
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, Rutgers University School of Nursing, Newark, New Jersey, and Englewood Health, Englewood, New Jersey
- Rachele Isip, MS, RN, APN-c, CWOCN, Englewood Health, Englewood, New Jersey
- Mary Reid, MS, RN, APN-c, Englewood Health, Englewood, New Jersey
- Devin Hulme, BSN, RN, Englewood Health, Englewood, New Jersey
- Andrew Marra, BS, Englewood Health, Englewood, New Jersey
| | - Rachele Isip
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, Rutgers University School of Nursing, Newark, New Jersey, and Englewood Health, Englewood, New Jersey
- Rachele Isip, MS, RN, APN-c, CWOCN, Englewood Health, Englewood, New Jersey
- Mary Reid, MS, RN, APN-c, Englewood Health, Englewood, New Jersey
- Devin Hulme, BSN, RN, Englewood Health, Englewood, New Jersey
- Andrew Marra, BS, Englewood Health, Englewood, New Jersey
| | - Mary Reid
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, Rutgers University School of Nursing, Newark, New Jersey, and Englewood Health, Englewood, New Jersey
- Rachele Isip, MS, RN, APN-c, CWOCN, Englewood Health, Englewood, New Jersey
- Mary Reid, MS, RN, APN-c, Englewood Health, Englewood, New Jersey
- Devin Hulme, BSN, RN, Englewood Health, Englewood, New Jersey
- Andrew Marra, BS, Englewood Health, Englewood, New Jersey
| | - Devin Hulme
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, Rutgers University School of Nursing, Newark, New Jersey, and Englewood Health, Englewood, New Jersey
- Rachele Isip, MS, RN, APN-c, CWOCN, Englewood Health, Englewood, New Jersey
- Mary Reid, MS, RN, APN-c, Englewood Health, Englewood, New Jersey
- Devin Hulme, BSN, RN, Englewood Health, Englewood, New Jersey
- Andrew Marra, BS, Englewood Health, Englewood, New Jersey
| | - Andrew Marra
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, Rutgers University School of Nursing, Newark, New Jersey, and Englewood Health, Englewood, New Jersey
- Rachele Isip, MS, RN, APN-c, CWOCN, Englewood Health, Englewood, New Jersey
- Mary Reid, MS, RN, APN-c, Englewood Health, Englewood, New Jersey
- Devin Hulme, BSN, RN, Englewood Health, Englewood, New Jersey
- Andrew Marra, BS, Englewood Health, Englewood, New Jersey
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12
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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13
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Rauh EA, Colwell JC. A Stoma Nurse's Wishlist to Surgeons: Tips for Before, During, and After Stoma Creation. SEMINARS IN COLON AND RECTAL SURGERY 2023. [DOI: 10.1016/j.scrs.2023.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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14
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Nunes MLG, Martins L, Conceição de Gouveia Santos VL. Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese. J Wound Ostomy Continence Nurs 2023; 50:124-130. [PMID: 36867035 DOI: 10.1097/won.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version. DESIGN Psychometric (methodologic) evaluation of the instrument. SUBJECTS AND SETTING Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order. METHODS The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors. RESULTS The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study. CONCLUSION This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.
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Affiliation(s)
- Maristela Lopes Gonçalves Nunes
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
| | - Lina Martins
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
| | - Vera Lucia Conceição de Gouveia Santos
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
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McCartney T, Markwell A, Rauch-Pucher M, Cox-Reber J. CE: Caring for Patients After Ileostomy Surgery. Am J Nurs 2023; 123:36-41. [PMID: 36625529 DOI: 10.1097/01.naj.0000918676.20331.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
ABSTRACT After ileostomy surgery, patients require nutrition and hydration modifications to maintain electrolyte balances and prevent postoperative complications. In addition to becoming dehydrated, patients who have ileostomies can develop obstructions if care isn't taken to avoid certain kinds of foods. Moreover, changes to medications may be needed to manage ileostomy output or account for altered absorption. This article provides information on postoperative hydration, medication, and nutritional management to nurses caring for patients after ileostomy surgery.
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Affiliation(s)
- Teresa McCartney
- Teresa McCartney, Ashley Markwell, Mackenzie Rauch-Pucher , and Jessica Cox-Reber are wound ostomy nurses at Beaumont Hospital Dearborn in Dearborn, MI. Contact author: Teresa McCartney, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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16
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Encountering Ostomies in Acute Care: Peristomal Skin Changes. Adv Skin Wound Care 2023; 36:54-55. [PMID: 36537776 DOI: 10.1097/01.asw.0000897288.52973.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ABSTRACT Up to 80% of individuals with an ostomy experience a peristomal skin complication, which can result in significant healthcare issues. All clinicians working with patients with stomas need to be aware of the signs and symptoms of peristomal skin complications and basic strategies to address the most common cause of skin complications: leakage of stool or other effluent onto the skin. Use of an evidence-based, standardized instrument to guide peristomal assessment and selection of appropriate interventions can improve patient outcomes and increase meaningful collaboration between all members of the healthcare team. This case study addresses dilemmas of care during a non-ostomy-related hospitalization.
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Dis Colon Rectum 2022; 65:1173-1190. [PMID: 35616386 DOI: 10.1097/dcr.0000000000002498] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Ambe PC, Kugler CM, Breuing J, Grohmann E, Friedel J, Hess S, Pieper D. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy - A systematic review and meta-analysis. Colorectal Dis 2022; 24:904-917. [PMID: 35297146 DOI: 10.1111/codi.16118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022]
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.
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Affiliation(s)
- Peter C Ambe
- GFO Kliniken Rhein-Berg, Vinzenz Pallotti Hospital, Bergisch Gladbach, Germany.,Department of Health, Witten/Herdecke University, Witten, Germany
| | | | - Jessica Breuing
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Julia Friedel
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.,University of Cologne, Cologne, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
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Mineccia M, Valenti A, Gonella F, Palisi M, Massucco P, Ricotti A, Ferrero A. A close adherence to a stoma-therapeutic pathway improves immediate stoma-related outcomes and reduces the length of hospital stay. Int J Colorectal Dis 2022; 37:1719-1725. [PMID: 35688952 DOI: 10.1007/s00384-022-04200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE New stoma creation is related to a wide range of implications and stoma-related complications could occur frequently. The aim was to assess the impact of a close stoma-therapeutic-care pathway (STCP) in terms of length of stay, autonomy in the management of the pouch, readmission rate, and stoma-related complications. METHODS Patients undergoing surgery for colorectal disease and first stoma creation from January 2017 to December 2020 were analyzed. All patients enrolled had joined the Enhanced Recovery after Surgery (ERAS) protocol. RESULTS Among 143 enrolled, 56 (40%) did not completely follow the STCP (group A), whereas 87 (60%) demonstrated strict compliance (group B). The hospital stay lasted 8 days in group B and 11.5 in group A (p = 0.001). The first look at the stoma needed 1 day in group B and 3 days in group A (p < 0.001), emptying the pouch 2 days in group B and 5 days in group A (p < 0.001). Finally, the ability to change the pouch was 3 days in group B and 6 days in group A (p < 0.001). Nine (16.1%) stoma-related complications were counted in group A and 16 (18.4%) in group B, and 30-day readmission was 10.1% in group B and 11.5% in group A (p = 0.82 and p = 1, respectively, not significant). CONCLUSIONS The STCP has been shown to reduce the hospital stay and to have a protective role making the patient autonomous in the management of the stoma.
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Affiliation(s)
- Michela Mineccia
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy.
| | - Antonio Valenti
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Federica Gonella
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Marco Palisi
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Paolo Massucco
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Andrea Ricotti
- Clinical Trial Unit, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Alessandro Ferrero
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
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Dellafiore F, Caruso R, Bonavina L, Udugampolage NS, Villa G, Russo S, Vangone I, BaronI I, Di Pasquale C, Nania T, Manara DF, Arrigoni C. Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis. Curr Med Res Opin 2022; 38:1103-1113. [PMID: 35608158 DOI: 10.1080/03007995.2022.2081455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor. METHODS A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS). RESULTS Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%. CONCLUSIONS The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.
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Affiliation(s)
- Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Russo
- ItalyVascular Surgery Unit, IRCCS Policlinic San Matteo Foundation, Nursing degree course, University of Pavia, section Istituti Clinici di Pavia e Vigevano S.p.A., Pavia, Italy
| | - Ida Vangone
- Department of Oncology and Hematology-Oncology, Istituto Europeo Oncologia, Milan, Italy
| | - Irene BaronI
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Tiziana Nania
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Duilio F Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
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Stoma-Related Complications: A Single-Center Experience and Literature Review. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: The creation of an abdominal stoma is a common procedure performed by surgeons as a part of the treatment for benign and malignant conditions in general surgery. Stoma formation is simple, but sometimes the associated postoperative complications have an impact on the patients’ physical and psychological state. The majority of complications do not require reoperation, but when it is indicated, we have to assess the most appropriate option for the patient.
Material and Methods: We conducted a retrospective study in a single surgical center, the Department of Surgery, Mureș County Hospital, Târgu Mureș, Romania, using data from patients who have been admitted under elective conditions for stoma-related complications between 2005 and 2019.
Results: A total number of 877 ostomies (653 colostomies and 224 ileostomies) were performed, and 157 patients (17.9%) developed some type of stoma complication and required surgical intervention. The mean age was 64.5 ± 2.1 years, with a male-female ratio of 1.3 to 1. The leading comorbidities included cardiovascular disease (52.2% of cases), obesity (22.2%), and diabetes (18.4%). Parastomal hernia was the most frequent complication (47.5% of cases), followed by stoma prolapse (23.4%), parastomal stenosis (20.3%), and parastomal infection (8.2%). There was an association between age and the type of complication: parastomal hernia, stoma prolapse, and stenosis were more frequent in the elderly; parastomal infection was more prevalent in young patients. A longer hospital stay was observed in case of parastomal hernia.
Conclusions: Stoma formation is associated with significant morbidity. Typically, the complications appear in the elderly. Conservative treatment is essential, but some of the late complications, such as parastomal hernia, stoma stenosis, stoma prolapse, and parastomal infection, require a surgical solution. Parastomal hernias are the most common complications, frequently associated with comorbidities and prolonged hospitalization.
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22
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Kingan MJ, Kump K. Getting Ready for Ostomy Certification: Preventing Complications and Promoting Patient Autonomy Through Pre- and Postoperative Education. J Wound Ostomy Continence Nurs 2022; 49:290-293. [PMID: 35523245 DOI: 10.1097/won.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael J Kingan
- Michael J. Kingan, DNP, AGPCNP-BC, CWOCN, Johns Hopkins Community Physicians, Baltimore, Maryland
- Kathy Kump, DNP, RN, MSN, MHSA, CWOCN, FNP , Ottawa University, Overland Park, Kansas
| | - Kathy Kump
- Michael J. Kingan, DNP, AGPCNP-BC, CWOCN, Johns Hopkins Community Physicians, Baltimore, Maryland
- Kathy Kump, DNP, RN, MSN, MHSA, CWOCN, FNP , Ottawa University, Overland Park, Kansas
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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