SSAT - EXTRACTION SITE OUTCOMES FOLLOWING SUBTOTAL COLECTOMY IN ULCERATIVE COLITIS AT A SINGLE LARGE URBAN TERTIARY CARE CENTER

Back to 2018 Posters

EXTRACTION SITE OUTCOMES FOLLOWING SUBTOTAL COLECTOMY IN ULCERATIVE COLITIS AT A SINGLE LARGE URBAN TERTIARY CARE CENTER
Christopher R. LaChapelle^*, Stewart Whitney, Allison Salk, Songhon Hwang, Alexander Greenstein
Surgery, The Mount Sinai Hospital, New York, NY

INTRODUCTION: Ulcerative colitis frequently requires surgery as a definitive management strategy in the setting of infection, malignancy and refractory disease. The colonic specimens can be extracted from various sites including a midline incision, the site of new stoma creation, a Pfannenstiel incision as well as other incisions. It is unclear if one extraction site is superior to others.

METHODS: After obtaining IRB approval at our institution, a large all encompassing colorectal database maintained at our single, large, urban medical center was queried for patients undergoing subtotal colectomy between January 1, 2008 and December 31, 2016. All charts were then screened for a diagnosis of ulcerative colitis. Homeless and incarcerated patients were excluded from the study. After identifying subjects, charts were explored for all data points up to 2 years following their surgery. Statistical analysis was then completed using R (Version 3.2.3, GUI 1.66 Mavericks build (7060)). Fisher's exact tests were used to analyze categorical variables and analysis of variance tests were used to assess continuous variables.

RESULTS: One-hundred eighty-three patients met inclusion criteria and were included in analysis. The majority of patients (n=110, 61.1%) had their colon removed through a midline incision, followed by stoma site (n=48, 26.7%) and Pfannenstiel incision (n=19, 10.6%). Patients with a midline incision were the oldest with a mean age of 43.9 years. Patients in each group were similar in regards to medical comorbidities. Patients with previous hernias were less likely to have a midline incision extraction site (36.4%, p=0.035), however patients with midline incision extraction were more likely to be on pre-operative steroids (p=0.009). At 30 days, patients with stoma site extraction represented a significantly higher proportion of readmissions to the hospital than expected (35.0%, p=0.038). At 2 years, patients with midline incisions exhibited the highest proportion of incisional hernias (n=11, 84.6%) followed by Pfannenstiel incisions (n=1, 7.7%) (p=0.018). There were no incisional hernias in the stoma site group. Of note, the patients with stoma site extractions did have increased referral and need for wound ostomy nurse (WOCN) care (n=10, 66.7%, p=0.009).

CONCLUSION: Stoma site extraction in subtotal colectomy for ulcerative colitis is an optimal choice as it is associated with fewer hernias and improved cosmesis. There is an increased risk for readmission within 30 days and a greater need for WOCN referral which clinicians should be aware of. In the event that the specimen cannot be extracted through the stoma site, a Pfannenstiel incision is the next most preferred extraction site with very few post-operative complications.

PATIENT CHARACTERISTICS
OVERALL
N=183 MIDLINE STOMA SITE PFANNENSTIEL OTHER p-value
AGE IN YEARS - MEAN (SD) 41.2 43.9 (17.8) 36.4 (17.9) 34.9 (13.7) 44.3 (20.6) 0.019
SEX MALE 77 45 (59.2) 20 (26.3) 10 (13.2) 1 (1.3) 0.812
RACE -WHITE 152 95 (63.3) 37 (24.7) 17 (11.3) 1 (0.7) 0.537
RACE - BLACK 4 3 (75.0) 1 (25.0) 0 0 -
RACE -HISPANIC 3 3 (100.0) 0 0 0 -
RACE - ASIAN 3 2 (66.7) 1 (33.3) 0 0 -
RACE - OTHER 10 5 (50.0) 2 (20.0) 2 (20.0) 1 (10.0) -
HTN 35 22 (64.7) 9 (26.5) 1 (2.9) 2 (5.8) 0.096
DM 14 9 (64.3) 4 (28.6) 1 (7.1) 0 1.000
CAD 8 7 (87.5) 1 (12.5) 0 0 0.530
COPD 3 2 (66.7) 1 (33.3) 0 0 1.00
ASTHMA 15 9 (60.0) 4 (26.7) 2 (13.3) 0 0.938
BIOLOGICS 89 48 (55.2) 30 (34.5) 9 (10.3) 0 0.075
PRE-OP STEROIDS 119 85 (71.4) 27 (22.7) 7 (5.9) 0 0.009
PREVIOUS HERNIA 11 4 (36.4) 3 (27.3) 3 (27.3) 1 (9.1) 0.035

OUTCOMES
OVERALL MIDLINE STOMA SITE PFANNENSTIEL OTHER p-value
30 Day READMISSION 20 9 (45.0) 7 (35.0) 2 (10.0) 2 (10.0) 0.038
30 Day RE-OPERATION 18 11 (61.1) 3 (16.7) 3 (16.7) 1 (5.6) 0.238
30 Day PARASTOMAL HERNIA 1 1 (100.0) 0 0 0 1.00
30 Day INCISIONAL HERNIA 1 1 (100.0) 0 0 0 1.00
30 Day WOCN 6 3 (50.0) 3 (50.0) 0 0 0.489
2 Year READMISSION 23 12 (52.2) 11 (47.8) 0 0 0.058
2 Year RE-OPERATION 19 11 (61.1) 5 (27.8) 1 (5.6) 1 (5.6) 0.362
2 Year PARASTOMAL HERNIA 20 13 (68.4) 4 (21.1) 1 (5.3) 1 (5.3) 0.288
2 Year INCISIONAL HERNIA 14 11 (84.6) 0 1 (7.7) 1 (7.7) 0.018
2 Year WOCN 15 5 (33.3) 10 (66.7) 0 0 0.009

Back to 2018 Posters