Abstract：
BACKGROUND: Neonates with intestinal perforation often require laparotomy and intestinal stoma creation, with the stoma placed in either the laparotomy incision or a separate site. We aimed to investigate if stoma location is associated with risk of postoperative wound complications.
METHODS: A multi-institutional retrospective review was performed for neonates ≤3 mo who underwent emergent laparotomy and intestinal stoma creation for intestinal perforation between January 1, 2009 and April 1, 2021. Patients were stratified by stoma location (laparotomy incision versus separate site). Outcomes included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression identified factors associated with postoperative wound complications, controlling for gestational age, age and weight at surgery, and diagnosis.
RESULTS: Overall, 79 neonates of median gestational age 28.8 wk (interquartile range [IQR]: 26.0-34.2 wk), median age 5 d (IQR: 2-11 d) and median weight 1.4 kg (IQR: 0.9-2.42 kg) had perforated bowel from necrotizing enterocolitis (40.5%), focal intestinal perforation (31.6%), or other etiologies (27.8%). Stomas were placed in the laparotomy incision for 41 (51.9%) patients and separate sites in 38 (48.1%) patients. Wound infection/dehiscence occurred in 7 (17.1%) neonates with laparotomy stomas and 5 (13.2%) neonates with separate site stomas (P = 0.63). There were no significant differences in peristomal irritation, stoma retraction, or stoma stricture between the two groups. On multivariable regression, separate site stomas were associated with increased likelihood of prolapse (odds ratio 6.54; 95% confidence interval: 1.14-37.5).
CONCLUSIONS: Stoma incorporation within the laparotomy incision is not associated with wound complications. Separate site stomas may be associated with prolapse. Patient factors should be considered when planning stoma location in neonates undergoing surgery for intestinal perforation.
METHODS: A multi-institutional retrospective review was performed for neonates ≤3 mo who underwent emergent laparotomy and intestinal stoma creation for intestinal perforation between January 1, 2009 and April 1, 2021. Patients were stratified by stoma location (laparotomy incision versus separate site). Outcomes included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression identified factors associated with postoperative wound complications, controlling for gestational age, age and weight at surgery, and diagnosis.
RESULTS: Overall, 79 neonates of median gestational age 28.8 wk (interquartile range [IQR]: 26.0-34.2 wk), median age 5 d (IQR: 2-11 d) and median weight 1.4 kg (IQR: 0.9-2.42 kg) had perforated bowel from necrotizing enterocolitis (40.5%), focal intestinal perforation (31.6%), or other etiologies (27.8%). Stomas were placed in the laparotomy incision for 41 (51.9%) patients and separate sites in 38 (48.1%) patients. Wound infection/dehiscence occurred in 7 (17.1%) neonates with laparotomy stomas and 5 (13.2%) neonates with separate site stomas (P = 0.63). There were no significant differences in peristomal irritation, stoma retraction, or stoma stricture between the two groups. On multivariable regression, separate site stomas were associated with increased likelihood of prolapse (odds ratio 6.54; 95% confidence interval: 1.14-37.5).
CONCLUSIONS: Stoma incorporation within the laparotomy incision is not associated with wound complications. Separate site stomas may be associated with prolapse. Patient factors should be considered when planning stoma location in neonates undergoing surgery for intestinal perforation.
摘要：
背景：肠穿孔的新生儿通常需要剖腹手术和造肠造口，将造口放置在剖腹手术切口或单独的部位。我们旨在调查造口位置是否与术后伤口并发症的风险相关。
方法：在2009年1月1日至2021年4月1日期间，对≤3个月因肠穿孔而接受紧急剖腹手术和肠造口手术的新生儿进行了多机构回顾性研究。根据造口位置（剖腹手术切口与单独部位）对患者进行分层。结果包括伤口感染/裂开，造口刺激，撤回,狭窄,和脱垂。多变量回归确定与术后伤口并发症相关的因素，控制胎龄，手术时的年龄和体重，和诊断。
结果：总体而言，79个新生儿的中位胎龄28.8wk（四分位数范围[IQR]：26.0-34.2wk），中位年龄5d（IQR：2-11d）和中位体重1.4kg（IQR：0.9-2.42kg）坏死性小肠结肠炎肠穿孔（40.5%），局灶性肠穿孔（31.6％），或其他病因（27.8%）。41例（51.9％）患者在剖腹手术切口中放置了气孔，38例（48.1％）患者分别放置了不同的部位。7例（17.1％）剖腹造口新生儿和5例（13.2％）单独造口新生儿发生伤口感染/裂开（P=0.63）。造口周围刺激没有显着差异，造口回缩,或两组之间的造口狭窄。在多元回归中，不同部位的气孔与脱垂的可能性增加相关(比值比6.54;95%置信区间:1.14~37.5).
结论：开腹手术切口内的造口合并与伤口并发症无关。分离部位的气孔可能与脱垂有关。在计划接受肠穿孔手术的新生儿的造口位置时，应考虑患者因素。
方法：在2009年1月1日至2021年4月1日期间，对≤3个月因肠穿孔而接受紧急剖腹手术和肠造口手术的新生儿进行了多机构回顾性研究。根据造口位置（剖腹手术切口与单独部位）对患者进行分层。结果包括伤口感染/裂开，造口刺激，撤回,狭窄,和脱垂。多变量回归确定与术后伤口并发症相关的因素，控制胎龄，手术时的年龄和体重，和诊断。
结果：总体而言，79个新生儿的中位胎龄28.8wk（四分位数范围[IQR]：26.0-34.2wk），中位年龄5d（IQR：2-11d）和中位体重1.4kg（IQR：0.9-2.42kg）坏死性小肠结肠炎肠穿孔（40.5%），局灶性肠穿孔（31.6％），或其他病因（27.8%）。41例（51.9％）患者在剖腹手术切口中放置了气孔，38例（48.1％）患者分别放置了不同的部位。7例（17.1％）剖腹造口新生儿和5例（13.2％）单独造口新生儿发生伤口感染/裂开（P=0.63）。造口周围刺激没有显着差异，造口回缩,或两组之间的造口狭窄。在多元回归中，不同部位的气孔与脱垂的可能性增加相关(比值比6.54;95%置信区间:1.14~37.5).
结论：开腹手术切口内的造口合并与伤口并发症无关。分离部位的气孔可能与脱垂有关。在计划接受肠穿孔手术的新生儿的造口位置时，应考虑患者因素。
