School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.
Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
Int J Colorectal Dis. 2023 Sep 25;38(1):238. doi: 10.1007/s00384-023-04523-5.
BACKGROUND: Stoma formation is a commonly performed procedure both during and following colorectal surgery. When designed correctly, stomas can dramatically improve patients' quality of life, but the reverse may occur when complications arise. Given the significant negative impact of complications following stoma formation, understanding risk factors that may be mitigated pre-operatively is important. METHOD: A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in May 2022. Data was extracted and a narrative synthesis undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the included studies. The systematic review includes various research designs such as randomised controlled trials (RCT), case-control studies, and observational cohort studies written in English. Reviews, conference papers, opinion papers, and those including participants < 18 years old were excluded. No restrictions on the date of publication and study setting were applied. RESULTS: This review included 17 studies, conducted between 2001 and 2020. The study designs were prospective audit, prospective analysis, retrospective analysis, longitudinal analysis and multivariate analysis of self-reported questionaires/surveys. Twenty-two possible risk factors for the development of stoma complications following stoma formation were identified. These include demographical risk factors, underlying medical condition, type of surgery, elective vs emergency surgery, stoma factors, surgical factors, indications for surgery and factors which may impact healing. Furthermore, high BMI, emergency surgery, and stoma type were identified as the most frequently occurring risk factors. CONCLUSION: Given the large number of risk factors identified, the implementation of a risk stratification tool may decrease the incidence and prevalence of stoma complication development. This, in turn, would decrease the associated healthcare-related costs, and negative impact on mortality, length of stay and quality of life.
背景：造口术是结直肠手术过程中或之后经常进行的一种程序。如果设计得当，造口术可以显著提高患者的生活质量，但如果出现并发症，情况可能会相反。鉴于造口术后并发症的负面影响巨大，了解可以在术前减轻的风险因素非常重要。
方法：2022 年 5 月，我们使用 MEDLINE、CINAHL 和 Cochrane 数据库对出版物进行了系统检索。提取数据并进行叙述性综合分析。循证图书馆学 (EBL) 清单评估了纳入研究的方法学质量。本系统评价包括各种研究设计，如随机对照试验 (RCT)、病例对照研究和观察性队列研究，这些研究均以英文撰写。排除了综述、会议论文、观点论文以及包含参与者年龄<18 岁的论文。未对出版物日期和研究地点设置限制。
结果：本综述纳入了 17 项研究，研究时间为 2001 年至 2020 年。研究设计为前瞻性审计、前瞻性分析、回顾性分析、纵向分析和自我报告问卷/调查的多变量分析。确定了 22 个可能导致造口术后发生造口并发症的风险因素。这些因素包括人口统计学风险因素、潜在的医疗状况、手术类型、择期手术与急诊手术、造口因素、手术因素、手术指征以及可能影响愈合的因素。此外，高 BMI、急诊手术和造口类型被确定为最常见的风险因素。
结论：鉴于确定的风险因素数量众多，实施风险分层工具可能会降低造口并发症发生的发生率和流行率。这反过来又会降低相关的医疗保健相关成本，以及对死亡率、住院时间和生活质量的负面影响。
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