What is the fate of an Ostomy following Emergency Laparotomy?
Published Date: 15th July 2020
Publication Authors: Javed M, Ting L, Appleton ND, Chadwick M, Rajaganeshan R, Kalaiselvan R
Purpose
To analyse outcomes of patients undergoing emergency laparotomy and stoma formation particularly: stoma reversal, stoma associated complications (SAC) and cost implications.
Methods
Retrospective analysis of 57 patients identified from NELA database between January 2014 and December 2015.
Results
Median age was 72 years (IQR: 60–82), M:F = 25:32. The median time duration between admission and stoma formation was 3 days (IQR: 1–8), median P‐POSSUM mortality and morbidity scores were 22.7% (IQR: 5.1%‐42.3%) and 90.7% (IQR: 66.4%‐97.2%) respectively. 31 patients had a colostomy (54.4%), 17 had an ileostomy (29.8%) and 9 had other stomas (15.8%). Median length of hospital stay (LOS) was 14 days (IQR: 8–24) and inpatient mortality was 21%. At the end of the 2‐year follow up, 13 patients had died (29%) and 18 underwent stoma reversal (40%). The reversal rate of ileostomies vs colostomies was 47.1% (8/17) vs 25.8% (8/31), P‐value < 0.05. Median time duration for colostomy reversal was 267.5 days (IQR: 186.5–394.5) while ileostomy reversal was 409.5 days (IQR: 77.0–622.3). Majority of the patients (83%) reported a SAC and on average spent 35 days per patient in hospital over a 2‐year period. Median duration of stoma‐related admission recorded at 6.5 days (IQR: 4–12) adding up to 1,016 days over the follow‐up period. Total cost of readmissions with SAC was £2,43,840 (£5,419 per patient) and total clinical follow‐up cost was £14,852 (£330 per patient).
Conclusion
Most patients with stomas following emergency laparotomies develop SAC with significant cost implications. Restoring gastrointestinal continuity at an early stage should be considered.
Javed, MA; Ting, LX; Appleton, N; Chadwick, M; Rajaganeshan, R; Samad, A; Kalaiselvan, R. (2020). What is the fate of an Ostomy following Emergency Laparotomy?. Colorectal Disease. 22 (S1), 17