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Morbidity and mortality in patients undergoing fecal diversion as an adjunct to wound healing: a NSQIP comparison study

  • Matthew E. PontellEmail author
  • Robert Kucejko
  • Dane Scantling
  • Michael Weingarten
  • David Stein
Original Paper

Abstract

Background

Fecal diversion for chronic, non-healing wounds improves quality of life, assists in wound healing, and helps to prepare for reconstructive surgery. While commonplace, little has been published regarding the safety of diversion in this patient subgroup. The purpose of this study is to elucidate the morbidity and mortality of fecal diversion for chronic wounds and to identify those patients with disproportionately high perioperative risk.

Methods

Retrospective analyses were performed using the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database and an institutional database. The primary outcome analyzed was 30-day mortality and secondary outcomes included 30-day morbidity and readmission rate.

Results

Eight hundred fifty-nine patients were identified in the NSQIP database who underwent diversion compared to 3990 who did not. In unmatched data, there were no significant differences in substantial 30-day morbidities. In matched data, diverted patients had a significantly lower perioperative mortality. Fifty-six patients were identified in the institutional review who were diverted for non-healing wounds. Fifty percent of patients with a preoperative ejection fraction of less than 30% died within 30 days of surgery (LR 6.58, p = 0.045).

Conclusions

The NSQIP review indicates that fecal diversion does not inherently increase 30-day perioperative morbidity or mortality. While 30-day morbidity remains high, the institutional review suggests that patients with cardiac dysfunction contribute to the majority of complications. As such, an ejection fraction less than 30% may be a relative contraindication to immediate diversion. Medical optimization and elective diversion should be considered whenever feasible.

Level of Evidence: Level III, risk / prognostic study.

Keywords

NSQIP Decubitus wounds Diversion Stoma 

Notes

Compliance with ethical standards

Funding

No funding has been received for this study.

Conflict of interest

Matthew E. Pontell, Robert Kucejko, Dane Scantling, Michael Weingarten, David Stein declare that they have no conflict of interest.

Ethical statement

The Institutional Review Board granted ethical approval and did not require informed consent for this study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Matthew E. Pontell
    • 1
    Email author
  • Robert Kucejko
    • 1
  • Dane Scantling
    • 1
  • Michael Weingarten
    • 1
  • David Stein
    • 1
  1. 1.Department of SurgeryDrexel University College of MedicinePhiladelphiaUSA

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