STOMA PREDICTION TOOL FOR PATIENTS UNDERGOING ILEOCOLIC RESECTION
Mantaj S. Brar*1,2, Jessica Saini2, Amelia Boughn2, Erin Kennedy1,2, Helen MacRae1,2, Anthony De Buck1,2
1Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; 2Sinai Health, Toronto, ON, Canada
Background: Patients undergoing ileocolic resection are often concerned about the risk of needing a stoma. We lack accurate tools to inform patients about their risk of a stoma during the peri-operative period. Our aim was to develop a clinical applicable tool using patient, disease, and surgical factors available pre-operatively to estimate the need for a stoma among patients undergoing ileocolic resection.
Methods: We identified all patients undergoing an ileocolic resection between 2000 and 2019, inclusive at our high-volume center. We recorded patient characteristics, imaging findings, surgical details, and post-operative outcomes using our institutional IBD database and through chart review. The outcome of interest was the need for a stoma either intra-operatively or post-operatively. We generated a prognostic model using a logistic regression model with multiple imputation for missing data to identify risk factors, and internally validated the model via bootstrapping.
Results: Employing data from 936 consecutive ileocolic resections, of which 13% received a stoma, we identified the following risk factors: age, sex, disease phenotype, pre-operative anaemia, malnutrition, preoperative biologics, preoperative steroids, ASA 3 or 4, open surgery, and simultaneous resection of another intestinal segment. After applying optimism adjustment, the model demonstrated good discrimination (C-index 0.782), and excellent calibration (calibration slope 1.001, calibration-in-the-large 0.0006; see Figure 1 for calibration plot). We exported our model into an excel spreadsheet for single predictions and batch predictions for clinical use and external validation.
Conclusions: Our stoma prediction tool is able to accurately predict the need for a stoma among patients undergoing an ileocolic resection and may assist with patient counselling and informed decision making. Our tool requires external validation to ensure generalizability.
Back to 2023 Abstracts