Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy.
Division of Chirurgia Generale, ASL AT, Ospedale Cardinal Massaia, Corso Dante Alighieri 202, 14100, Asti, Italy.
Tech Coloproctol. 2024 Sep 22;28(1):129. doi: 10.1007/s10151-024-03001-6.
Patients affected by ulcerative colitis (UC) often require surgery, involving two or three-stage procedures, including ileostomy creation. While ileostomy has some advantages, it can lead to complications, such as dehydration. The aim of this study was to evaluate the impact of a new individualized stoma-therapeutic-care-pathway (STCP) on dehydration-related readmissions. Secondary endpoints were stoma-related complications.
The study compares two series of consecutive patients with UC undergoing diverting ileostomy during restorative ileo-pouch-anal-anastomosis. The STCP group consists of patients enrolled from January 2020 to December 2021 who followed the pathway. The older group was selected from 2015 to 2017 (control group). Clinical data were collected, including patient characteristics, hospital stay, complications, and readmissions. The study was approved by the local institutional review board.
Overall, 30-day dehydration-related readmission occurred in one (1.4%) versus nine (15.3%) patients in the STCP group versus control group, respectively (p = 0.005). In-hospital peristomal skin complications were significantly lower in STCP group (6 patients, 8.5%) versus control (35, 59.3%), as well as ostomy complications that occurred in 5 (7%) patients in the STCP group versus 8 (13.5%) in the control group (both p < 0.001). Ostomy complications reduced significantly in the STCP group after discharge (two patients, 2.8% versus eight, 13.5%), p = 0.001, and after 30-days (three patients, 4.2% versus five, 8.5%).
This study underscores the effectiveness of STCP in reducing dehydration-related readmissions and stoma-related complications in patients with UC undergoing stoma creation. It emphasizes the significance of patient education, close follow-up, and multidisciplinary care. Further research and standardized stoma education are essential.
溃疡性结肠炎（UC）患者常需手术治疗，包括两阶段或三阶段手术，包括造口术。虽然造口术有一些优点，但也会导致并发症，如脱水。本研究旨在评估新的个体化造口治疗护理路径（STCP）对与脱水相关的再入院的影响。次要终点为造口相关并发症。
该研究比较了两组连续接受预防性回肠造口术的 UC 患者，分别在 2020 年 1 月至 2021 年 12 月期间接受了分流性回肠造口术。STCP 组纳入了遵循该路径的患者。对照组为 2015 年至 2017 年的患者。收集了患者的临床资料，包括患者特征、住院时间、并发症和再入院情况。本研究得到了当地机构审查委员会的批准。
总体而言，STCP 组有 1 例（1.4%）患者发生 30 天内与脱水相关的再入院，而对照组有 9 例（15.3%）患者，差异有统计学意义（p=0.005）。STCP 组的经皮造口皮肤并发症发生率（6 例，8.5%）显著低于对照组（35 例，59.3%），STCP 组的造口并发症发生率（5 例，7%）也显著低于对照组（8 例，13.5%），差异均有统计学意义（均 p<0.001）。STCP 组患者出院后（2 例，2.8%）和 30 天后（3 例，4.2%）造口并发症发生率显著降低（p=0.001）。
本研究强调了 STCP 可有效降低 UC 患者造口术后与脱水相关的再入院率和造口相关并发症。它强调了患者教育、密切随访和多学科护理的重要性。进一步的研究和标准化的造口教育是必要的。
