OUTCOMES AFTER COLORECTAL SURGERY: THE EFFECT OF HAVING AN OSTOMY ON RENAL FAILURE AND READMISSION
Ipek Sapci2, Robert Fearn*1, Emre Gorgun2
1Gastroenterology, Homerton University Hospital, Irvine, CA; 2Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland, OH
Background:
Colorectal surgery for benign and malignant conditions commonly results in the formation of an excretory stoma with population prevalence rates as high as 2-4 per thousand. Ostomates are at risk of complications due to the lack of absorptive capacity of the bowel and changes in motility. The reported rates of complication vary considerably between studies and depend on definition and methodology. We aimed to evaluate the impact of the formation of an ostomy on rates of readmission and acute renal failure following major colorectal surgery.
Methods:
The American College of Surgeons- National Surgical Quality Improvement Program was used to identify 68,642 individuals who underwent a colorectal surgery resulting in ileostomy or colostomy between 2005-2016. Identification was based on the presence of CPT codes mentioning ileostomy or colostomy. A comparison cohort of 247,903 individuals was derived from CPT codes of similarly complex procedures that do not result in ileostomy or colostomy. The groups were compared for demographic characteristics and complications.
Results:
Age, sex, BMI, smoking status, and preadmission history of diabetes and dyspnea were comparable between the two groups. 1,128 individuals in the stoma group (1.64%) developed acute renal failure compared to 1,598 individuals in the non-stoma group (0.665%). 14% of the stoma group were readmitted at any stage vs 9% of the non-stoma group. Mean (SD) time to readmission in the stoma group was 16.7 (6.91) days vs 21.1 (6.31) in the non-stoma group.
Conclusion:
This data suggests that complications such as the occurrence of acute renal failure and hospital readmissions are over represented in patients who undergo surgery resulting in a stoma. This is consistent with previously published data at hospital level, but is the first to demonstrate the problem on a national scale. Improved education and better monitoring of stoma output, along with better mechanisms to identify patients at risk are essential in the addressing these issues.
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