Fecal diversion does not support healing of anus-near pressure ulcers in patients with spinal cord injury—results of a retrospective cohort study

Abstract

Study Design Retrospective cohort study including spinal cord injured patients with anus-near pressure ulcers. Objective The primary objective was to evaluate the impact of stool diversion via stoma on the decubital wound healing. Secondary objectives included the risk of complications and ulcer recurrence. Associations between the wound healing and potentially interfering parameters were determined. Setting University hospital with a spinal cord injury unit. Methods A total of 463 consecutive patients who presented with a decubitus were retrospectively included. Patients with and without a stoma were compared using descriptive and explorative statistics including multiple regression analysis. Results The severity of the pressure ulcers was determined as stage 3 in two-thirds and stage 4 in one-third of all cases. The wound healing lasted longer in the 71 stoma-presenting patients than in the 392 patients with undeviated defecation (77 vs. 59 days, p = 0.02). The age (regression coefficient b = 0.41, p = 0.02), the ASA classification (b = 16.04, p = 0.001) and the stage of the ulcers (b = 19.65, p = 0.001) were associated with prolonged ulcer treatment in the univariate analysis. The multiple regression analysis revealed that the fecal diversion (b = −18.19, p = 0.03) and the stage of the ulcers (b = 21.62, p = 0.001) were the only predictors of delayed wound healing. Conclusion The presence of a stoma is not related to improved wound healing of ulcers near the anus. On the contrary, stoma patients needed more time until complete wound healing, conceivably related to selection bias. Nonetheless, we currently do not recommend fecal diversion to be the standard concept for decubitus treatment.

Descriptive Analysis of Surgical Outcomes and Stoma Formation for Treating Sacral and Anal Pressure Injuries in Spinal Cord Injury: A Retrospective Study of Selected Cases

“…However, the evidence regarding the relationship between fecal contamination in patients with extensive PIs and the necessity for stoma placement remains inconclusive. Some studies, such as the 2021 retrospective cohort study ( Pussin et al, 2021 ), suggest that colostomies might not always be the optimal solution; the authors reported that stoma patients required more time (an average of 77 days) to achieve complete healing of anus-near PIs compared to non-stoma patients (59 days). Given the physical and psychological challenges associated with stoma formation, the study's authors concluded that a colostomy might not be the standard solution for all patients with PIs near the anus.…”

Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group

“…The working group concluded that, where appropriate, patients with pelvic PIs should undergo fecal diversion to reduce risk of downstream fecal contamination of the surgical site 91 . Surgical intervention should consider debridement of any necrotic bone or large bony prominences.…”

“…The working group concluded that, where appropriate, patients with pelvic PIs should undergo fecal diversion to reduce risk of downstream fecal contamination of the surgical site. 91 Surgical intervention should consider debridement of any necrotic bone or large bony prominences. In addition, multiple bone biopsies, harvested during debridement, should be sent to pathology to evaluate for osteomyelitis and to microbiology to identify bacterial pathogens for targeted antibiotic therapy.…”

Protocolo local de indicaciones quirúrgicas en lesiones por presión

“…Para el manejo de deposiciones existen estudios controversiales sobre la utilidad de colostomía (44) . Nuestro grupo recomienda utilizar el protocolo diseñado en conjunto con el equipo de Nutrición, el cual consiste en lograr deposiciones blandas para facilitar la higiene y en el caso de que la lesión sea < 6 cms desde el ano, se sugiere evaluar la derivación fecal (45) . 5.…”