Abstract：
BACKGROUND: Intestinal stomas are one of the most common parts of pediatric surgical care, and complications arising from it have significant impact on overall patient outcomes. However, data on major complications in low-middle-income countries remain limited. This pilot retrospective cohort study aimed to investigate the prevalence, types, and management of major stoma complications in pediatric patients at a tertiary government hospital in the Philippines.
METHODS: Medical records of pediatric patients with major stoma complications classified as Clavien-Dindo III-V from June 2018 to June 2023 were reviewed. Patient-related factors (age, sex, diagnosis) and surgery-related factors (stoma type and location, surgeon expertise) were analyzed. Descriptive statistics characterized demographic profiles, while Chi-square and t tests analyzed categorical and continuous variables, respectively. Multivariable logistic regression evaluated independent associations with major stoma complications.
RESULTS: Out of 1041 pediatric patients with stomas, 102 cases had major complications, representing a prevalence rate of 9.8%. Mortality directly attributed to stoma complications accounted for 1.3% of the total cases, or 14 deaths in 5 years. Neonates comprised a significant portion, primarily diagnosed with congenital conditions like anorectal malformation and Hirschsprung\'s disease. Ileostomies exhibited a higher incidence of major complications compared to other stoma types. Stomal prolapse and adhesive bowel obstruction are the most common reported stoma complications requiring surgical intervention while stoma revision is the most frequent corrective procedure. The median time from stoma creation to presentation of major complication was 14 months, with nearly half of the complications occurring within the first year. Only the presence of ileostomy had significant association with the development of major complications among the risk factors analyzed.
CONCLUSIONS: This study provides useful insights into stoma complications in pediatric patients in a low-middle income country. Despite the lack of significant associations between the patient-related and surgeon-related factors, and major stoma complications, further investigation into other contributing factors is warranted. Improvements in data collection methods and prospective studies with larger sample sizes are recommended to enhance understanding and optimize care of major stoma complications. Addressing the challenges identified in this study could lead to a comprehensive and tailored approach to pediatric stoma care and their complications.
METHODS: Medical records of pediatric patients with major stoma complications classified as Clavien-Dindo III-V from June 2018 to June 2023 were reviewed. Patient-related factors (age, sex, diagnosis) and surgery-related factors (stoma type and location, surgeon expertise) were analyzed. Descriptive statistics characterized demographic profiles, while Chi-square and t tests analyzed categorical and continuous variables, respectively. Multivariable logistic regression evaluated independent associations with major stoma complications.
RESULTS: Out of 1041 pediatric patients with stomas, 102 cases had major complications, representing a prevalence rate of 9.8%. Mortality directly attributed to stoma complications accounted for 1.3% of the total cases, or 14 deaths in 5 years. Neonates comprised a significant portion, primarily diagnosed with congenital conditions like anorectal malformation and Hirschsprung\'s disease. Ileostomies exhibited a higher incidence of major complications compared to other stoma types. Stomal prolapse and adhesive bowel obstruction are the most common reported stoma complications requiring surgical intervention while stoma revision is the most frequent corrective procedure. The median time from stoma creation to presentation of major complication was 14 months, with nearly half of the complications occurring within the first year. Only the presence of ileostomy had significant association with the development of major complications among the risk factors analyzed.
CONCLUSIONS: This study provides useful insights into stoma complications in pediatric patients in a low-middle income country. Despite the lack of significant associations between the patient-related and surgeon-related factors, and major stoma complications, further investigation into other contributing factors is warranted. Improvements in data collection methods and prospective studies with larger sample sizes are recommended to enhance understanding and optimize care of major stoma complications. Addressing the challenges identified in this study could lead to a comprehensive and tailored approach to pediatric stoma care and their complications.
摘要：
背景：肠造口是儿科外科护理中最常见的部分之一，以及由此引起的并发症对患者的总体预后有重大影响。然而,关于中低收入国家主要并发症的数据仍然有限.这项试点回顾性队列研究旨在调查患病率，类型,以及菲律宾三级政府医院儿科患者的主要造口并发症的管理。
方法：回顾了2018年6月至2023年6月被分类为Clavien-DindoIII-V的主要造口并发症的儿科患者的病历。患者相关因素（年龄，性别,诊断)和手术相关因素(造口类型和位置，外科医生的专业知识)进行了分析。描述性统计数据以人口概况为特征，卡方检验和t检验分析了分类变量和连续变量，分别。多变量逻辑回归评估了与主要造口并发症的独立关联。
结果：在1041例小儿造口患者中，102例有严重并发症，患病率为9.8%。直接归因于造口并发症的死亡率占总病例的1.3%，5年内有14人死亡.新生儿占很大一部分，主要诊断为先天性疾病，如肛门直肠畸形和先天性巨结肠。与其他造口类型相比，回肠造口显示出更高的主要并发症发生率。气孔脱垂和粘连性肠梗阻是需要手术干预的最常见的造口并发症，而造口翻修是最常见的矫正程序。从造口到出现主要并发症的中位时间为14个月，近一半的并发症发生在第一年。在分析的危险因素中，只有回肠造口术的存在与主要并发症的发展显着相关。
结论：这项研究为中低收入国家的儿科患者造口并发症提供了有用的见解。尽管患者相关因素和外科医生相关因素之间缺乏显著关联，和主要的造口并发症，需要进一步调查其他影响因素。建议改进数据收集方法和更大样本量的前瞻性研究，以增强对主要造口并发症的理解和优化护理。解决这项研究中发现的挑战可能会导致对儿科造口护理及其并发症的全面和量身定制的方法。
方法：回顾了2018年6月至2023年6月被分类为Clavien-DindoIII-V的主要造口并发症的儿科患者的病历。患者相关因素（年龄，性别,诊断)和手术相关因素(造口类型和位置，外科医生的专业知识)进行了分析。描述性统计数据以人口概况为特征，卡方检验和t检验分析了分类变量和连续变量，分别。多变量逻辑回归评估了与主要造口并发症的独立关联。
结果：在1041例小儿造口患者中，102例有严重并发症，患病率为9.8%。直接归因于造口并发症的死亡率占总病例的1.3%，5年内有14人死亡.新生儿占很大一部分，主要诊断为先天性疾病，如肛门直肠畸形和先天性巨结肠。与其他造口类型相比，回肠造口显示出更高的主要并发症发生率。气孔脱垂和粘连性肠梗阻是需要手术干预的最常见的造口并发症，而造口翻修是最常见的矫正程序。从造口到出现主要并发症的中位时间为14个月，近一半的并发症发生在第一年。在分析的危险因素中，只有回肠造口术的存在与主要并发症的发展显着相关。
结论：这项研究为中低收入国家的儿科患者造口并发症提供了有用的见解。尽管患者相关因素和外科医生相关因素之间缺乏显著关联，和主要的造口并发症，需要进一步调查其他影响因素。建议改进数据收集方法和更大样本量的前瞻性研究，以增强对主要造口并发症的理解和优化护理。解决这项研究中发现的挑战可能会导致对儿科造口护理及其并发症的全面和量身定制的方法。
