Early stoma-related complications in end-colostomy patients: A prospective single-center study

Abstract

Background: End colostomies are performed frequently in both emergency and elective abdominal surgery. The aim of this study was to assess early stoma-related complications and to identify risk factors for severe complications. Methods: All patients undergoing surgery with an end colostomy during 2018–2020 at Tampere University Hospital were identified. This was a single-center study based on a prospective stoma registry complemented with additional retrospective clinical data. A stoma-related complication was classified as severe (Clavien-Dindo grade ⩾3a) or mild (<3a). Results: The study comprises 360 patients (median age = 71, interquartile range = 64–78 years); 197 (55%) patients were male, and out of these 360 patients, 242 (67%) underwent elective operation and 118 (33%) underwent emergency surgery. There were 18/118 (15%) severe stoma-related complications in the emergency and 12/242 (5%) in the elective group. Stoma site was marked preoperatively for 53/118 (45%) in the emergency group and for 235/242 (97%) patients in the elective group. Most of the stomas were performed by a specialist or resident in gastrointestinal surgery (95%, 342/360). In univariate analyses, emergency surgery (odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.6–7.4, p = 0.002), smoking (OR = 2.9, 95% CI = 1.3–6.8, p = 0.01), lack of experience in gastrointestinal surgery of the operating surgeon (OR = 4.9, 95% CI = 1.6–14.8, p = 0.05, unmarked stoma site (OR = 2.3, 95% CI = 1.0–5.2, p = 0.04), and American Society of Anesthesiologists (ASA) score IV–V (OR = 2.7, 95% CI = 1.2–6.0, p = 0.01) showed increased risk of severe stoma complications. In multivariate logistic regression analysis, smoking (OR = 3.3, 95% CI = 1.3–7.9, p = 0.009) was associated with severe stoma complications. Conclusion: Morbidity associated with end colostomy is common, especially in emergency surgery. Smoking was the only independent risk factor for severe short-term stoma complications. Stoma site planning and cessation of smoking may reduce stoma-related complications.