Preoperative stoma site marking reduces postoperative stoma-related complications in emergency surgery: A single center retrospective cohort study

Abstract

Background and objective: Stoma site marking is an important factor in reducing stoma-related complications, thereby influencing the long-term quality of life in the elective setting. The impact of preoperative stoma site marking in emergency stoma creation is largely unknown. We aimed to determine whether preoperative stoma site marking in emergency stoma creation reduces stoma-related complications. Methods: Patients who underwent emergency stoma creation at our hospital between 2009 and 2022 were examined by reviewing our prospective database and retrospective chart review. Subjects were classified into the “marking (+)” or “marking (−)” group according to stoma site marking (194 and 151 patients, respectively). The changes in the frequency of stoma marking over time and the effects of stoma marking on stoma-related complications were analyzed. Results: The overall frequency of grade 2 or higher stoma-related complications was lower in the marking (+) group than in the marking (−) group (24% versus 36%, p = 0.010). Stoma site marking was associated with fewer soma site bleeding (2% versus 10%, p < 0.001), and the frequency of peristomal dermatitis was also lower (10%) in the marking (+) group (versus 18%, p = 0.042). Moreover, the lack of stoma site marking was an independent risk factor for overall stoma-related complications (adjusted odds ratio: 1.69, p = 0.034). Conclusions: Preoperative stoma site marking was associated with stoma-related complications in emergency surgery. The clinical significance of our attempt is worth validating with prospective studies.

Stoma formation: An underestimated challenge in emergency surgery

“…Preoperative stoma site marking might reduce stoma complications, but it is difficult in the emergency setting. 5 Nozawa et al 3 achieved stoma site marking in the majority of their emergency cases by improving hospital routines. The study encompasses a large cohort, but significant differences in stoma complications between marked and unmarked patients were limited to bleeding and peristomal dermatitis.…”

“…The study encompasses a large cohort, but significant differences in stoma complications between marked and unmarked patients were limited to bleeding and peristomal dermatitis. 3 The long study period might have affected the results as stoma techniques and stoma equipment may have changed. Laparoscopic surgery might have negative effects on stoma construction, especially if the bowel is extracted through the stoma site.…”

“…1 Several risk factors have been identified, one being emergency surgery. 2 Two cohort studies in the current issue investigated stoma construction in the acute care surgery setting 3,4 —one focusing on preoperative stoma site marking and the other one on risk factors for stoma complications specifically between elective and emergency surgery.…”