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Colostomy vs. Ileostomy -an ACS-NSQIP Evaluation of Complications From Diverting Stoma Reversal
Dhruvil R. Shah*1, Yueju LI2, Laurel Beckett2, David Wisner1, Steve R. Martinez1, Vijay P. Khatri1
1Surgery, University of California Davis, Sacramento, CA; 2Public Health Sciences, University of California, Davis, CA
Background: The optimal method of fecal diversion remains controversial as either colostomy or ileostomy may be sufficient. Perioperative outcomes associated with subsequent stoma reversal may inform the decision of which diversion method to use. Our aim was to evaluate perioperative morbidity and mortality associated with colostomy and ileostomy reversal.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent diverting stoma reversal between 2005 and 2008. Patients were excluded if the type of stoma reversal could not be ascertained via CPT or ICD-9 code. Outcomes evaluated included overall morbidity (≥ 1 serious complication), mortality, wound infections, and total surgical length of stay. Multivariate analysis identified patient- and procedure-related risk factors associated with each outcome. We reported adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).
Results: A total of 5190 patients met inclusion criteria. There were 2188 colostomy reversals and 3002 ileostomy reversals. The colostomy reversal group had a significantly higher median operative time (151min vs. 75min, p<0.01). The number of contaminated and dirty wounds was similar between both types of stoma reversal(49% vs. 49). There was no significant difference in mortality, median surgical length of stay, or re-operation rates. On multivariate analysis, the following preoperative factors were significant predictors of postoperative morbidity: Cr>2.0 (aOR 1.99, 95% CI :1.33-2.93), WBC between 10-20 (aOR 1.44, 95% CI:1.13-1.81), moderate exertional dyspnea (aOR 1.94, 95% CI: 1.47-2.53), and ASA status greater than 3 (aOR 1.79, 95%CI:1.53-2.10). Colostomy reversal was also associated with higher odds of overall morbidity (aOR 1.28, 95% CI:1.08-1.50) and wound infections (aOR 1.70, 95%CI :1.39-2.07).
Conclusion: Colostomy reversal is associated with increased overall morbidity, wound infections, and nearly twice the operative time compared to ileostomy reversal. These factors should be considered when deciding which type of diverting stoma to perform.
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