Jordan Stephanie, Hui Nathan, Doudle Mark, Von Papen Michael, Naik Arun, Lu Cu Tai, Nolan Gregory, Cooper Michelle
Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia.
ANZ J Surg. 2022 Mar;92(3):403-408. doi: 10.1111/ans.17411. Epub 2021 Dec 10.
The purpose of a loop ileostomy is to temporarily divert faeces away from a distal anastomosis, to reduce the consequences of anastomotic leak. This ultimately requires a second procedure to restore bowel continuity, which confers risk of complications including the development of Clostridioides difficile infection (CDI). It is hypothesized that patients who undergo loop ileostomy reversal are at increased risk of CDI when compared with other patients undergoing elective colorectal surgical procedures, and that these patients also experience an increased length of stay (LOS).
A retrospective cohort study was performed on all patients who underwent loop ileostomy reversal at the Gold Coast Hospital and Health Service between 1 January 2012 and 31 December 2019.
Two hundred and twenty-eight patients were identified. Eight tested positive for CDI on faecal PCR (3.51%), a higher incidence than that in patients who underwent an elective colorectal surgical procedure during the same period (0.83%) (RR = 4.23). Additionally, median LOS for ileostomy reversal patients was significantly increased in those who also had CDI when compared with those without CDI (11 versus 4 days; P = 0.0003).
The study confirmed that the incidence of CDI was higher in those who underwent ileostomy reversal when compared with an otherwise comparable hospital population (elective colorectal surgery patients). Additionally, those patients who underwent ileostomy reversal and had CDI experienced an increased LOS which translates to increased cost to the healthcare system. Further investigation into pre-operative screening and prophylactic antibiotics should be considered as a measure to mitigate this post-operative complication.
回肠袢式造口术的目的是暂时使粪便改道，远离远端吻合口，以减少吻合口漏的后果。这最终需要进行第二次手术来恢复肠道连续性，这带来了包括艰难梭菌感染（CDI）发生在内的并发症风险。据推测，与接受择期结直肠手术的其他患者相比，接受回肠袢式造口术还纳术的患者发生CDI的风险增加，并且这些患者的住院时间（LOS）也会延长。
对2012年1月1日至2019年12月31日期间在黄金海岸医院和卫生服务中心接受回肠袢式造口术还纳术的所有患者进行了一项回顾性队列研究。
共确定了228例患者。8例粪便PCR检测CDI呈阳性（3.51%），这一发生率高于同期接受择期结直肠手术的患者（0.83%）（相对危险度=4.23）。此外，与未发生CDI的回肠造口还纳术患者相比，发生CDI的患者的中位住院时间显著延长（分别为11天和4天；P=0.0003）。
该研究证实，与其他情况相当的医院人群（择期结直肠手术患者）相比，接受回肠袢式造口术还纳术的患者中CDI的发生率更高。此外，接受回肠袢式造口术还纳术且发生CDI的患者住院时间延长，这意味着医疗系统的成本增加。应考虑进一步研究术前筛查和预防性使用抗生素，作为减轻这种术后并发症的一项措施。
