Risk factors for reoperation after ileostomy reversal - Results from a prospective cohort study.
BACKGROUND
Ileostomy reversal is frequently performed in abdominal surgery. Postoperative complications after ileostomy reversal are encountered in around 20% of patients. Data regarding risk factors for reoperation after ileostomy closure are scarce. The purpose of this prospective trial was to determine risk factors for operative revision after ileostomy closure.


METHODS
This is an additional post hoc analysis of a two center prospective trial. After enrollment, patient characteristics and intraoperative details were analyzed. Patients were followed up at one postoperative visit before discharge and at a three months postoperative visit by standardized questionnaire. All reoperations occurring in the three months period after surgery were analyzed, and immediate reoperations which were directly related to the ileostomy reversal were analyzed separately.


RESULTS
118 patients with elective ileostomy reversal were included in the trial. 12 out of 106 patients (11.3%) underwent any reoperation within three months after surgery (Clavien-Dindo grade IIIb). On multivariate analysis, anemia was associated with any reoperation p = 0.004; OR 6.93 (95% CI 1.37-30.07). Six out of 114 patients (5.3%) required an immediate reoperation (small bowel perforation, anastomotic leakage, postoperative ileus, deep wound infection) due to surgical complications directly related to the ileostomy reversal. Higher body mass index and anemia were associated with immediate reoperations (BMI: p = 0.038; OR 0.73 (95% CI 0.55-0.98); anemia: p = 0.001; OR 25.50 (95% CI 3.87-168.21).


CONCLUSIONS
Surgical complications after ileostomy reversal occurred to a substantial extent. Rate of reoperations was associated with anemia and high body mass index. Optimizing patients in terms of preoperative hemoglobin and BMI may reduce surgical complications after ileostomy closure.
Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
V
V
Schneider
Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
L D
LD
Lee
Institute of Biometry and Clinical Epidemiology, Charité Campus Mitte, Charitéplatz 1, 10098 Berlin, Germany.
A
A
Stroux
German Society for General and Visceral Surgery, Schiffbauerdamm 40, 10117 Berlin, Germany.
H J
HJ
Buhr
Department of General and Visceral Surgery, HELIOS Kliniken Schwerin, Wismarsche Straße 393-397, 19049 Schwerin, Germany.
J P
JP
Ritz
Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
M E
ME
Kreis
Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. Electronic address: johannes.lauscher@charite.de.
J C
JC
Lauscher
D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery*; D000740:Anemia / Q000453:epidemiology; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D045823:Ileus / Q000453:epidemiology / Q000601:surgery*; D007416:Intestinal Perforation / Q000453:epidemiology / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D050177:Overweight / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013396:Suction / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery*
Ileostomy closure; Operative revision; Risk factors