Increased risk of complications in smokers undergoing reversal of diverting ileostomy

Abstract

Background Diverting ileostomy (DI) is utilised in rectal cancer surgery to mitigate the effects of anastomotic leak. The aim of this study was to assess the clinical risk factors associated with post‐operative complications of DI reversal. Methods A single‐centre retrospective analysis of patients who underwent surgical resection for rectal cancer and subsequent DI reversal between January 2012 and December 2020 was undertaken. Medical records were reviewed to extract clinical, operative and pathologic details and post‐operative complications according to the Clavien‐Dindo classification. Univariate and multivariable analyses were undertaken to assess risk factors associated with post‐operative complications of DI reversal. Results One hundred and twenty‐six adult patients who underwent DI reversal were included of which 49 had a post‐operative complication (39%). The most common complication was prolonged post‐operative ileus, which occurred in 24 patients (19%). On multivariable analysis smoking was significantly associated with overall complications (odds ratio [OR] = 5.60, 95% confidence interval [CI] 1.90–16.52, p = 0.0018), and high Clavien‐Dindo (2–5) category complications (OR = 4.60, 95% CI 1.81–11.68, p = 0.0013). In addition, patients who received adjuvant chemotherapy were less likely to have a reversal of DI complication (OR = 0.43, 95% CI 0.19–0.94, p = 0.0342) and less likely to have a high Clavien‐Dindo (2–5) category complication (OR = 0.44, 95% CI 0.20–0.93, p = 0.0311). Conclusion Smokers who have undergone surgical resection of rectal cancer have a significantly increased risk of post‐operative complications after DI reversal. In these patients, the importance of smoking cessation must be emphasised. The decreased complication rate observed in patients who received adjuvant chemotherapy was an unexpected finding.

Standardized digital solution with surgical procedure manager (SPM®)—an opportunity for maximizing patient safety and efficiency in ileostomy reversal?

“…The rate of severe postoperative complications (Clavien-Dindo III–V) between patients who underwent ileostomy reversal without and with SPM® was comparable. The overall rate of complications with 31.8% was comparable to the existing literature ( 15 , 16 ). The rate of anastomotic leak was 9.5% in group without SPM® and 4.2% in the group with SPM®.…”

Outcomes of Early versus Standard Closure of Diverting Ileostomy after Proctectomy

“…30 Another study 31 came to the conclusion that smoking is independently associated with complications after ileostomy closure. 31 The clinical implication of this meta-analysis is that early closure of DLI after proctectomy should be considered with caution as the risk of AL after early closure can be higher than after standard closure. If early closure is planned, it may be more safely done at least 2 weeks after DLI formation.…”

“…A previous study noted that smoking can double the incidence of wound complications after ileostomy reversal 30 . Another study 31 came to the conclusion that smoking is independently associated with complications after ileostomy closure 31 …”

Risk factors for postoperative ileus in hysterectomy: A systematic review and meta-analysis

“…In addition, tobacco contains nicotine substances, which can stimulate capillaries and cause contraction, affecting the blood supply at the surgical site, resulting in postoperative incision infection and poor healing, and thus affecting the postoperative gastrointestinal function recovery of patients [ 30 ]. Cribb et al [ 31 ] also support this view. The reason why this factor has low heterogeneity is that smoking is divided into former smokers (who have quit smoking) and current smokers, and the methods of data collection were inconsistent among different studies.…”