DOES PREOPERATIVE STOMA MARKING AND EDUCATION BY THE ENTEROSTOMAL THERAPIST AFFECT OUTCOME

INTRODUCTION: It is generally accepted that preoperative patient educa tion and skin marking for a stoma location are important in avoiding s toma complications. At our institution, enterostomal therapists are av ailable to educate and mark patients before their surgery. However, fo r various reasons, not all patients who had an elective stoma created, had preoperative skin marking or instructions on stoma care. Our regi stry of patients provided us with a means of comparing patients who ha ve undergone an elective stoma with (Group I) and without (Group II) p reoperative marking and education. METHODS: Our stoma registry consist ing of 1,790 patients was retrospectively reviewed from 1978 to 1996 t o assess all patients who underwent elective stoma construction. Patie nts included for review had a total of 593 elective stomas. All patien ts with stomas are followed by the enterostomal therapists postoperati vely and, therefore, were evaluated fur both early and late complicati ons. Early complications were defined as ang adverse event occurring w ithin 30 days of surgery and late complications as those occurring 30 days after surgery. RESULTS: Our enterostomal therapists preoperativel y evaluated 292 of the 593 patients planned for possible stoma creatio n. This included careful marking of the stoma site by having the patie nts lie down, sit, and stand and locating a stable flat area on the ab domen, taking into account the belt line and any abnormal skin creases or deformities, Patients were instructed on stoma appearance with a m odel and given basic stoma care instructions. Ln Group I, there were 9 5 (32.5 percent) complications (68 (23.3 percent) occurred early and 2 7 (9.25 percent) occurred late). There Mere 301 patients who did not r eceive preoperative evaluation (Group II). In this second group, 131 ( 43.5 percent) complications were found, (95 (31.6 percent) occurred ea rly and 36 (12 percent) occurred late). The difference in total number of complications between groups was determined to be statistically si gnificant, with a P value of <0.0075, as was the difference in early c omplications, with a P value of <0.03. The difference in late complica tions is not significant, with a P value of <0.54. CONCLUSIONS: These results confirm that preoperative evaluation by an enterostomal therap ist, marking of the skin site, and providing patient education reduce adverse outcomes. All elective procedures that may result in stoma for mation should, therefore, be assessed and marked preoperatively. Patie nts, likewise, should be informed and taught to care for their forthco ming stomas preoperatively and postoperatively.