Abstract：
OBJECTIVE: Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma-related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse. There is a paucity of research on specific risk factors within the emergency cohort for development of SRCs. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs within this cohort.
METHODS: Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3-year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs.
RESULTS: A total of 455 patients were included (median follow-up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24-5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35-0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92-5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01-8.69), p < 0.001] were risk factors for late SRCs.
CONCLUSIONS: Stoma-related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting.
METHODS: Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3-year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs.
RESULTS: A total of 455 patients were included (median follow-up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24-5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35-0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92-5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01-8.69), p < 0.001] were risk factors for late SRCs.
CONCLUSIONS: Stoma-related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting.
摘要：
目的：英国每年约有4000名患者形成紧急肠造口。造口相关并发症（SRC）是异质性的，但以前曾被细分为早期或晚期SRC，早期SRC通常发生在术后30天内。早期的SRC包括皮肤脱落，造口坏死和高产量，晚期SRC包括造口旁疝,退缩和脱垂。在紧急队列中，针对SRC开发的特定风险因素的研究很少。本文旨在描述紧急肠道手术后SRCs的发生率，并确定该队列中SRCs的潜在危险因素。
方法：连续接受紧急形成肠造口的患者（结肠造口术，回肠造口术或空肠造口术）在3年的时间内从ELLSA（急诊剖腹手术和腹腔镜苏格兰审计）数据库中前瞻性地从三个急性医院站点中识别出。所有患者均随访至少1年。使用多变量逻辑回归模型来识别早期和晚期SRC的危险因素。
结果：共纳入455例患者（中位随访19个月，中位年龄64岁，男性：女性0.52，56.7%回肠造口）。54.1%的患者经历了早期SRC，而51%的人经历了晚期SRC。共有219例患者（48.1％）在术前造口。早期SRC的危险因素包括末端回肠造口术形成[OR3.51（2.24-5.49），p<0.001],而术前造口定位被发现是保护性的[OR0.53（0.35-0.83），p=0.005]。患者肥胖[OR3.11（1.92-5.03），p<0.001]和择期手术后并发症的再次手术[OR4.18（2.01-8.69），p<0.001]是晚期SRC的危险因素。
结论：急诊手术后造口相关并发症很常见。术前造口选址是减少SRC的唯一真正可改变的风险因素，进一步的研究应针对在紧急情况下提高频率和准确性的方法。
方法：连续接受紧急形成肠造口的患者（结肠造口术，回肠造口术或空肠造口术）在3年的时间内从ELLSA（急诊剖腹手术和腹腔镜苏格兰审计）数据库中前瞻性地从三个急性医院站点中识别出。所有患者均随访至少1年。使用多变量逻辑回归模型来识别早期和晚期SRC的危险因素。
结果：共纳入455例患者（中位随访19个月，中位年龄64岁，男性：女性0.52，56.7%回肠造口）。54.1%的患者经历了早期SRC，而51%的人经历了晚期SRC。共有219例患者（48.1％）在术前造口。早期SRC的危险因素包括末端回肠造口术形成[OR3.51（2.24-5.49），p<0.001],而术前造口定位被发现是保护性的[OR0.53（0.35-0.83），p=0.005]。患者肥胖[OR3.11（1.92-5.03），p<0.001]和择期手术后并发症的再次手术[OR4.18（2.01-8.69），p<0.001]是晚期SRC的危险因素。
结论：急诊手术后造口相关并发症很常见。术前造口选址是减少SRC的唯一真正可改变的风险因素，进一步的研究应针对在紧急情况下提高频率和准确性的方法。
