Defunctioning loop ileostomy for pelvic anastomoses:  predictors of morbidity and nonclosure.
OBJECTIVE
The aim of this study was to determine the morbidity of a defunctioning loop ileostomy and the subsequent closure rate, and to identify the predictors of complications and nonclosure of stoma.


METHODS
This study is a retrospective review of a single-institution experience.


METHODS
All patients who underwent a planned temporary defunctioning loop ileostomy performed synchronously with a pelvic anastomosis during a 6-year period were included.


METHODS
The primary outcome measures were the ileostomy complication rate for the entire spectrum of care, readmission and reoperation rates to treat ileostomy complications, and subsequent closure rate. Patient and treatment factors were evaluated for their independent effect on complications and closure rate with the use of multivariable logistic regression.


RESULTS
One hundred twenty-three patients were identified (median age, 51 years). Of these patients, 64.2% developed ≥1 minor or major ileostomy complications (13.8% during index hospitalization, 52.8% as outpatient, and 23.4% after closure). Readmitted for dehydration following ileostomy formation were 11.4% of patients. The ileostomy was closed in 76.4% of patients with 8.6% requiring a midline laparotomy. The overall ileostomy-related reoperation rate was 10.4% (2.4% during index hospitalization, 1.6% at readmission, and 6.4% following ileostomy closure). Obesity (BMI ≥30 kg/m) was associated with a higher overall ileostomy complication rate (OR 8.56, 95% CI 1.64-44.74) and outpatient complication rate (OR 7.69, 95% CI 2.48-23.81). Age >65 years (OR 53.34, 95% CI 4.21-676.14) and hypertension (OR 8.36, 95% CI 1.09-64.43) increased the risks of high ileostomy output and dehydration. Obesity (OR 4.61, 95% CI 1.14-18.54) and smoking (4.47, 95% CI 1.43-13.98) decreased the likelihood of ileostomy closure.


CONCLUSIONS
This study was limited by its retrospective nature.


CONCLUSIONS
The morbidity of a defunctioning loop ileostomy remains significant. Obesity is an independent predictor of ileostomy complications. Older age and hypertension increase the risks of high-output stoma and dehydration. Almost one quarter of patients never have the ileostomy closed. Obesity and smoking are associated with less likelihood of a subsequent ileostomy closure.
Department of Surgery, Kaiser Permanente, 4760 Sunset Blvd., Los Angeles, CA 90027, USA.
Linda J
LJ
Chun
Philip I
PI
Haigh
Michael S
MS
Tam
Maher A
MA
Abbas
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000517:prevention & control; D002648:Child; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007082:Ileum / Q000601:surgery*; D007420:Intestine, Large / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D058106:Wound Closure Techniques; D055815:Young Adult