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Indian Journal of Surgery

, Volume 81, Issue 5, pp 468–473 | Cite as

Could Forming a Stoma Alongside from the Principal Surgery Predict Mortality Among Operative Parameters?

  • Oguzhan Ozsay
  • Serkan Karaisli
  • Fevzi CengizEmail author
  • Kemal Erdinc Kamer
  • Haldun Kar
  • Gülden Balli
  • Turan Acar
  • Osman Nuri Dilek
Original Article
  • 50 Downloads

Abstract

Stoma surgery is a more morbid procedure in colorectal surgery, compared to other procedures. In the predictive scoring systems, the mortality associated with colorectal surgery is evaluated by a combination of physical and operative parameters; however, stoma surgery is not addressed individually among the operative parameters. This study aims to determine whether the surgeons, who decide in the formation of stomata, own an acquired ability to predict mortality. Four hundred thirteen patients who underwent ileostomy and colostomy formation were included in the study. All patients were evaluated in two time periods: the first 30 days after surgery (short) and in the long term. As a result, short- and long-term mortality rates were observed to be high with statistical significance. When the patients with various etiologies but with the same surgery conditions, in the short term, no statistical differences were observed in the mortality rates statistically; however, by the multivariate analysis, the mortality rates were found to be 1809 times more in patients with benign etiologies. High mortality rates with statistical significance were observed in the long term in patients with malignancies. In conclusion, the decision on stoma requirement is a predictor of mortality both in the early period and in the long term. Stoma must be included in the future colorectal surgery mortality prediction scoring systems, individually and aside from the surgical intervention, as a factor increasing the potential for mortality.

Keywords

Stoma Ostomy surgery Mortality prediction 

Notes

Compliance with Ethical Standards

Disclaimer

This manuscript is original and neither published, accepted, or submitted for publication elsewhere.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Presentation

This work has not been presented in any meeting.

References

  1. 1.
    Sheetz KH, Waits SA, Krell RW, Morris AM, Englesbe MJ, Mullard A, Campbell DA, Hendren S (2014) Complication rates of ostomy surgery are high and vary significantly between hospitals. Dis Colon Rectum 57:632–637.  https://doi.org/10.1097/DCR.0000000000000038 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gibbons G, Tan CJ, Bartolo DC et al (2015) Emergency left colonic resections on an acute surgical unit: does subspecialization improve outcomes? ANZ J Surg 85:739–743.  https://doi.org/10.1111/ans.13160 CrossRefPubMedGoogle Scholar
  3. 3.
    Lewis MA, Hendrickson AW, Moynihan TJ (2011) Oncologic emergencies: pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin 61:287–314.  https://doi.org/10.3322/caac.20124 CrossRefPubMedGoogle Scholar
  4. 4.
    Harris DA, Eqbeare D, Jones S, Benjamin H, Woodward A, Foster ME (2005) Complications and mortality following stoma formation. Ann R Coll Surg Engl 87:427–431.  https://doi.org/10.1308/003588405X60713 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Antolovic D, Reissfelder C, Ozkan T et al (2011) Restoration of intestinal continuity after Hartmann’s procedure--not a benign operation. Are there predictors for morbidity? Langenbeck’s Arch Surg 396:989–996CrossRefGoogle Scholar
  6. 6.
    Zorcolo L, Covotta L, Carlomagno N, Bartolo DC (2003) Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization. Dis Colon Rectum 46:1461–1467.  https://doi.org/10.1007/s00423-011-0763-1 CrossRefPubMedGoogle Scholar
  7. 7.
    Kwan TL, Lai F, Lam CM et al (2008) Population-based information on emergency colorectal surgery and evaluation on effect of operative volume on mortality. World J Surg 32:2007–2082CrossRefGoogle Scholar
  8. 8.
    Broderic RC, Fushs HF, Harnsberger CR et al (2015) The price of decreased mortality in the operative management of diverticulitis. Surg Endosc 29:1185–1191.  https://doi.org/10.1007/s00268-008-9632-7 CrossRefGoogle Scholar
  9. 9.
    Schilling MK, Maurer CA, Kollmar O, Büchler MW (2001) Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey stages III and IV): a prospective outcome and cost analysis. Dis Colon Rectum 44:699–703.  https://doi.org/10.1007/BF02234569 CrossRefPubMedGoogle Scholar
  10. 10.
    Richter S, Lindemann W, Kollmar O, Pistorius GA, Maurer CA, Schilling MK (2006) One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV). World J Surg 30:1027–1032.  https://doi.org/10.1007/s00268-005-0439-5 CrossRefPubMedGoogle Scholar
  11. 11.
    Oguz A, Gümüş M, Turkoglu A, Bozdağ Z, Ülger BV, Agaçayak E, Böyük A (2015) Fournier’s gangrene: a summary of 10 years of clinical experience. Int Surg 100:934–941.  https://doi.org/10.9738/INTSURG-D-15-00036.1 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Li YD, Zhu WF, Qiao JJ, Lin JJ (2014) Enterostomy can decrease the mortality of patients with Fournier gangrene. World J Gastroenterol 20:7950–7954.  https://doi.org/10.3748/wjg.v20.i24.7950 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kızıltan R, Yılmaz Ö, Aras A, Çelik S, Kotan Ç (2016) Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer. Med Glas (Zenica) 13:62–67.  https://doi.org/10.17392/831-16 CrossRefGoogle Scholar
  14. 14.
    Arumugam PJ, Bevan L, Macdonald L, Watkins AJ, Morgan AR, Beynon J, Carr ND (2003) A prospective audit of stomas--analysis of risk factors and complications and their management. Color Dis 5:49–52.  https://doi.org/10.1046/j.1463-1318.2003.00403.x CrossRefGoogle Scholar
  15. 15.
    Van Arendonk KJ, Tymitz KM, Gearhart SL, Stem M, Lidor AO (2013) Outcomes and costs of elective surgery for diverticular disease: a comparison with other diseases requiring colectomy. JAMA Surg 148:316–321.  https://doi.org/10.1001/jamasurg.2013.1010 CrossRefGoogle Scholar
  16. 16.
    Ng HJ, Yule M, Twoon M, Binnie NR, Aly EH (2015) Current outcomes of emergency large bowel surgery. Ann R Coll Surg Engl 97:151–156.  https://doi.org/10.1308/003588414X14055925059679 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bozzetti F, Nava M, Bufalino R, Menotti V, Marolda R, Doci R, Gennari L (1983) Early local complications following colostomy closure in cancer patients. Dis Colon Rectum 26:25–29.  https://doi.org/10.1007/BF02554674 CrossRefPubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  1. 1.General SurgeryIzmir Katip Celebi University Ataturk Training and Research HospitalIzmirTurkey
  2. 2.Department of SurgeryIzmir Katip Celebi University Ataturk Training and Research HospitalIzmirTurkey

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