R. J. Hollis1, L. Li1, C. Lam1, J. P. Ricci2, A. Zimmern2 1North Shore University And Long Island Jewish Medical Center, Department Of General Surgery, Manhasset, NY, USA 2North Shore University And Long Island Jewish Medical Center, Division Of Colorectal Surgery, Manhasset, NY, USA
Introduction:
Ileostomy creation is frequently performed by colorectal and general surgeons as well as surgical oncologists. They are often created to protect distal anastomoses or due to concern that restoring downstream continuity would result in complications secondary to the critical status of the patient, gross contamination, or poor perfusion. Once created, the probability of ileostomy reversal and the timing of reversal are important considerations for patient quality of life but can be difficult to predict. This study retrospectively reviewed the outcomes of patients who had ileostomies created over a five-year period to better understand what factors are associated with reversal and early reversal.
Methods:
Data were collected on 332 patients who had surgery with ileostomy creation from July 2014 to September 2019 at five hospitals belonging to a large healthcare system in the Northeast. Follow up information was recorded until August 2020, with either death or reversal of the ileostomy as the endpoint of data collection. Early reversal was defined as reversal within 90 days from ileostomy creation. Patients who died during the follow up period were excluded, leaving 291 patients that were included in the final analysis. Statistical analyses consisted of demographics, Fisher’s Exact Test, and multivariate regression, which were performed with GraphPad Prism (Boston, MA).
Results:
Overall, 332 patient charts were reviewed, and 41 (12.3%) were excluded due to death during the study's observation period. Males accounted for 158 (54.3%) patients, and the mean age was 59 (range 1 to 90 years). Ileostomies were reversed in 185 (63.8%) patients, and of these, 40 (21.6%) were reversed early. Indications for surgery included cancer (21.6%), perforated viscus (17.2%), diverticulitis (12.7%), Crohn’s disease (10.7%), ulcerative colitis (9.3%), colostomy reversal (5.2%), and gastrointestinal bleed (1.4%). 85 (29.2%) of the cases were emergent, and two thirds of the ileostomies were loop ileostomies. Average time to reversal was 160 days (range 41 to 693). Factors associated with reversal included male sex (p=0.0357), surgery for diverticulitis (p=0.0001), surgery for colostomy reversal (p=0.0001), non-emergent surgery (p=0.0001), and loop ileostomy (p=0.0001). The only factor associated with early reversal was history of any cancer (p=0.0015).
Conclusion:
Most patients were reversed later than 90 days after ileostomy creation. Females, patients with end ileostomies, and patients undergoing emergency surgery were less likely to be reversed. Patients with diverticular disease were more likely to be reversed. Most of these factors are known preoperatively and can be used to counsel patients on their chances of reversal and early reversal. In addition, surgeons can work proactively with patients who are at high risk of late reversal or non-reversal to improve their quality of life.