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The Safety of Outpatient Stoma Closure: on the Verge of a Paradigm Shift?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

An area of contention among colorectal surgeons is when it is safe to discharge patients who have undergone closure of diverting ostomies. This study aimed to review the trends in outpatient stoma closure (OSC), to assess the safety of this practice, and to identify appropriate surgical candidates for the outpatient procedure.

Methods

Patients were queried from the ACS National Surgical Quality Improvement Program database (2005–2016). Main outcomes included Clavien-Dindo (C-D) III–V class surgical complications, and readmission. Outpatient stay was defined as a hospital stay of less than or equal to 1 day. Multivariable logistic regression analysis was used to identify risk factors for C-D III–V complications and readmission.

Results

Of 24,393 patients, 668 (2.74%) underwent an OSC. OSC has increased over the last decade (3.16% 2005–2006, 4.14% 2016, p < 0.001). Outpatients had significantly lower ASA class and fewer comorbidities than inpatients. Outpatient complication rate was significantly lower than the inpatient rate (2.99% vs. 7.25%, p < 0.001). Readmissions were comparable (8.92% outpatient vs. 9.77% inpatient, p = 0.54). ASA > 2, smoking, COPD, dyspnea, steroid use, bleeding disorder, and partial/total dependency were associated with increased risk of complications and readmission. Patients without any risk factors had lower complication (4.75%) and readmission rates (8.09%) compared to those with ≥ 2 risk factors (11.50% complication and 13.07% readmission rate, p < 0.001).

Conclusions

There is an increasing trend in the percentage of stoma closures being performed as outpatient procedures. Appropriate selection of patients preoperatively who are suitable candidates for OSC can be helpful in managing patient expectations and hospital resources.

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Support

Mr. Edwin Lewis provided generous support of Dr. Efron’s Department of Surgery Research Fund.

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA

    James P. Taylor, Miloslawa Stem, Sophia Y. Chen, David Yu, Sandy H. Fang, Susan L. Gearhart, Bashar Safar & Jonathan E. Efron

  2. Queen’s University School of Medicine, Kingston, Canada

    David Yu

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  1. James P. Taylor
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  2. Miloslawa Stem
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Contributions

James P. Taylor – Concept, design, interpretation, drafting work, writing manuscript

Miloslawa Stem – Concept, design, data analysis and interpretation, writing manuscript

Sophia Y. Chen – Design, interpretation, revising manuscript

David Yu – Design, interpretation, revising manuscript

Sandy H. Fang – Manuscript revision and interpretation

Susan L. Gearhart – Manuscript revision and interpretation

Bashar Safar – Manuscript revision and interpretation

Jonathan E. Efron – Concept, design, revising manuscript

Corresponding author

Correspondence to Jonathan E. Efron.

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This study was reviewed and approved by the Institutional Review Board of the Johns Hopkins University School of Medicine.

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Meetings

This paper was presented as a poster at ASCRS, Nashville, May 19–23 2018, and was presented as a podium presentation at the International Society of University Colon and Rectal Surgeons, London, August 29–September 1 2018, and as a podium presentation at the Canadian Association of General Surgeons, St John, September 13–15.

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Taylor, J.P., Stem, M., Chen, S.Y. et al. The Safety of Outpatient Stoma Closure: on the Verge of a Paradigm Shift?. J Gastrointest Surg 23, 2019–2026 (2019). https://doi.org/10.1007/s11605-018-4001-9

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