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Predictors of Postoperative Complications Associated with Loop Ileostomy Closure
Tamar B. Nobel*, Jordan A. Munger, David Chessin, Daniel Popowich, Stephen R. Gorfine, Joel Bauer
Surgery, The Mount Sinai Hospital, New York, NY
Introduction: A defunctioning loop ileostomy is often utilized to protect an anastomosis at high risk for leakage with the aim of reducing incidence of postoperative complications. Despite the associated benefits, loop ileostomies themselves are not without complications. Previous studies have demonstrated significant morbidity and mortality associated with the closure of a loop ileostomy. The objective of this study was to identify patient factors predictive of complications following loop ileostomy closure and to determine the morbidity and mortality rate associated with this procedure in a large series of patients.
Methods: A retrospective review of a prospectively maintained database was used to identify patients who underwent loop ileostomy closure from 1981-2011 at a single surgical practice. Demographic, surgical, pathologic and postoperative outcome data were collected. Risk factors evaluated include age, gender, pre-operative lab tests, interval time between creation and closure, weight change between procedures, perioperative steroid use, indication for ileostomy, pathology and anastomosis type for ileostomy closure. Postoperative complications evaluated in this study include anastomotic leak, small bowel obstruction (SBO), hernia, bleeding, urinary tract infection (UTI), urinary retention, fistula, reoperation and death. Descriptive and univariate analysis was used to evaluate differences between patents who experienced complications following ileostomy closure and those who did not.
Results: 350 patients were identified who underwent ileostomy closure. Median age was 37.9 years (range: 12-95). The majority of patients were male (n=206, 59%). The most common diagnosis was ulcerative colitis (n=233, 66.6%) and most common indication for ileostomy was for protection of ileal J-pouch-anal anastomosis (n=116, 33%). Median time from ileostomy creation to closure was 102 days (range: 18-960). 62 patients (18%) had a postoperative complication. SBO was most common (n=34, 9.7%), and leak rate was 1.7% (n=6). 3 patients died (mortality rate: 0.9%). Risk factors for a postoperative complication are summarized in Table 1.
Conclusions: In our series, closure of a loop ileostomy was associated with an 18% morbidity rate. Predictors of complications after loop ileostomy closure were age and lower preoperative albumin and hemoglobin levels. These factors should be considered when assessing safety of ileostomy closure.
Independent Risk Factors for Any Complication
| | No Complication
(n=288) | Complication
(n=62) | P-Value | Age (years)
| 39.5 | 45.6 | 0.005* | | Albumin | 3.9 | 3.4 | 0.02* | | Hemoglobin | 11.8 | 11.1 | 0.03* | | Interval Between Creation and Closure (days) | 100.5 | 107.5 | 0.86 | | Weight Change between Creation and Closure (kg) | -1.8 | -2.7 | 0.66 |
significant difference; p<0.05
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