Outcomes of diverting loop ileostomy reversal in the elderly: a case–control study

Abstract

Background Although diverting loop ileostomy (DLI) reversal is considered to be a relatively simple procedure, it is not immune from major morbidity. We aimed to compare outcomes of DLI reversal between elderly and non‐elderly patients. Methods Retrospective review of all patients who underwent DLI reversal at a single tertiary medical centre between 2010 and 2020. The elderly group consisted of patients 70 or older compared to a control group of those younger than 70 years. Results During the study period, 307 patients underwent DLI reversal. Of these, 76 patients were in the elderly group (mean age 75.6) and 231 in the control group (mean age 55.3). The groups were comparable in terms of mean time interval between the creation of the ileostomy and reversal (242 versus 255 days, respectively, P = 0.5), choice between stapled and hand‐sewn anastomoses (97.4% stapled anastomosis versus 93.1%, P = 0.086), median post‐operative length of stay (5 days in both, P = 0.086), rates of post‐operative complications (26.3% versus 26.8%, P = 0.99), severe complications (5.3% versus 6.9%, P = 0.81) and 30‐day readmission rates (13.2% versus 10.8%, P = 0.58). Multivariate analysis found the time interval between the creation of the stoma and its reversal to be the only significant risk factor for major post‐operative morbidity. Age was not found to be correlated with post‐operative morbidity. Conclusion The outcomes of loop ileostomy reversal in elderly patients are similar to non‐elderly patients. Efforts should be made to decrease the time interval between the creation of the stoma and its reversal as this is a significant risk factor for major post‐operative morbidity.

Outcomes on diverting ostomy formation and reversal after low anterior resection in the older more advanced rectal cancer patient

“…The morbidity described in earlier studies on patients of all ages was comparable to our results. Moreover, a recent study confirmed that older age is not associated with an increased risk for morbidity after ostomy reversal [30]. However, patients should be informed about the need for a secondary procedure for ostomy reversal and the associated risk for complications before deciding to undergo a LAR with a primary anastomosis and the formation of a diverting ostomy.…”

Association of Frailty With Post-Operative Outcomes of Older Adults Undergoing Elective Ostomy Reversal

“…Prior literature shows that in the majority of cases, age is not an independent risk factor for morbidity following ostomy reversal. 18,20,[26][27][28] For example, several studies showed that age was not associated with increased morbidity after ileostomy 18,26 or Hartmann's reversal. 20,28 Similarly, Bosshardt et al found that even age over 70 years was not predictive of complications following ostomy closure.…”