title: Increased postoperative complications after protective ileostomy closure delay: An institutional study.
abstract: OBJECTIVE
  To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure.
  
  
  METHODS
  A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.
  
  
  RESULTS
  The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037).
  
  
  CONCLUSIONS
  Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.
authors.affiliation: Ines Rubio-Perez, Miguel Leon, Daniel Pastor, Joaquin Diaz Dominguez, Ramon Cantero, General and Digestive Surgery Department, La Paz University Hospital, 28046 Madrid, Spain.
authors.forename: Ines
authors.initials: I
authors.lastname: Rubio-Perez
authors.affiliation: Ines Rubio-Perez, Miguel Leon, Daniel Pastor, Joaquin Diaz Dominguez, Ramon Cantero, General and Digestive Surgery Department, La Paz University Hospital, 28046 Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Leon
authors.affiliation: Ines Rubio-Perez, Miguel Leon, Daniel Pastor, Joaquin Diaz Dominguez, Ramon Cantero, General and Digestive Surgery Department, La Paz University Hospital, 28046 Madrid, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pastor
authors.affiliation: Ines Rubio-Perez, Miguel Leon, Daniel Pastor, Joaquin Diaz Dominguez, Ramon Cantero, General and Digestive Surgery Department, La Paz University Hospital, 28046 Madrid, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Diaz Dominguez
authors.affiliation: Ines Rubio-Perez, Miguel Leon, Daniel Pastor, Joaquin Diaz Dominguez, Ramon Cantero, General and Digestive Surgery Department, La Paz University Hospital, 28046 Madrid, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Cantero
keywords: Colorectal surgery; Protective ileostomy; Stoma-related complications; Stomas; Surgical infections