Stoma complications - The Cook County Hospital experience

PURPOSE: A retrospective analysis of enteric stomas per formed at Cook Coun ty Hospital was undertaken to evaluate stoma complications per stoma type a nd configuration and operating service. In addition, me attempted to identi fy factors predictive of increased enteric stoma complications. METHODS: Fr om 1976 to 1995, data cards on 1,616 patients with stomas were compiled by Cook County Hospital enteric stomal therapists. Data card information inclu ded age, gender, weight, early and late stoma complications, emergency stat us, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stomal therapist. Data were then analyzed using a logistic regression model to identify those variables that influenced the rate of complications. RESULTS: There were 553 (34 per cent) patients with complications. Among the total complications, 448 (28 p ercent) occurred early (<1 month postoperative), and 105 (6 percent) occurr ed late (>1 month). The most common early complications were skin irritatio n (12 percent), pain associated with poor stoma location (7 percent), and p artial necrosis (5 percent). The most common late complications were skin i rritation (6 percent), prolapse (2 percent), and stenosis (2 percent). The enteric stoma with the most complications was the loop ileostomy (75 percen t). The enteric stoma with the least complications was the end transverse c olostomy (6 percent). The general surgery service had the most complication s (47 percent), followed by gynecology (44 percent), surgical oncology (37 percent), colorectal (32 percent), pediatric surgery (29 percent), and trau ma (25 percent). Age, operating service, enteric stoma type and configurati on, and preoperative enteric stomal therapist marking were found to be vari ables that influenced stoma complications. CONCLUSIONS: Complications from enteric stoma construction are common. Preoperative enteric stoma site mark ing, especially in older patients, and avoiding the ileostomy, particularly in the loop configuration, can help minimize complications.