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the Effect of Fecal Diversion on Infectious Complications Following Low Colorectal Surgery
Ahmad I. Elnahas*, Allan Okrainec, Fayez a. Quereshy, Timothy Jackson
General Surgery, University of Toronto, Toronto, ON, Canada
Introduction: The use of a diverting stoma in patients with a low colorectal anastomosis has been advocated to avoid infectious complications. The objective of this study was to evaluate the effect of fecal diversion on the 30-day anastomotic leak, wound infection, and postoperative ileus rates following colorectal resection with a low anastomosis.
Methods and Procedures: A retrospective cohort study was conducted using data from the National Surgery Quality Improvement Program (2011-2012). Patients who underwent a colorectal resection with a low (i.e. pelvic) anastomosis were included in the study population. CPT coding indicating the presence of a diverting stoma was used to classify groups. The study outcomes included the 30-day wound infection, anastomotic leak and postoperative ileus rates. A multivariable logistic regression model was performed for each outcome to adjust for confounding.
Results: A total of 886 and 3858 patients were in the stoma and non-stoma group, respectively. Baseline characteristics were clinically similar between the two groups. The 30-day anastomotic leak, wound infection and ileus rate in the stoma group was 3.1% 9.6% and 16.3%, respectively. After adjustment for clinically relevant confounders, the 30-day anastomotic leak rate was significantly lower with fecal diversion (OR 0.56, p = 0.025, 95% CI [0.34 - 0.93]). As well, presence of a diverting stoma did not appear to affect the 30-day wound infection rate (OR 1.16, p = 0.34 95% CI [0.86 - 1.56]) or postoperative ileus rate (OR 1.11, p = 0.39 95% CI [0.87 - 1.41]).
Conclusions: Using this large national surgical database, fecal diversion appears to be associated with a lower 30-day anastomotic leak rate in patients with a low colorectal anastomosis. However, the presence of a diverting stoma had no significant effect on the 30-day wound infection or postoperative ileus rate. Surgeons should strongly consider the use of a diverting stoma for patients undergoing low colorectal surgery.
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