MacDonald Scott, Gallagher Anna, McNicholl Lauren, McElroy Luke, Hughes Rebecca, Quasim Tara, Moug Susan
Department of Surgery, Royal Alexandra Hospital, Paisley, Scotland.
Department of Surgery, Golden Jubilee University National Hospital, Clydebank, Scotland.
World J Emerg Surg. 2025 Mar 29;20(1):26. doi: 10.1186/s13017-025-00598-3.
Restoration of intestinal continuity is a key consideration for patients having a stoma created under emergency conditions. There is contrasting evidence about the outcomes of stoma reversal for these patients. This research aims to describe the post-operative outcomes of stoma reversal after emergency formation, and whether these are affected by the timing of reversal.
A retrospective review of a prospectively maintained emergency laparotomy (EmLap) database for 4 hospitals was performed between 2018 and 2021. Adult patients undergoing emergency stoma formation were identified and followed up until 2024. Those undergoing stoma reversal surgery were included in the final analysis. A Cox proportional-hazards model was created to identify factors associated with increased time to reversal.
1775 patients had an EmLap, with 505 (28.5%) having a stoma created. Of those patients with a stoma, 97 patients (19.2%) died within one year post-operatively. 146 (28.9%) of the emergency stoma patients underwent stoma reversal, with median time to reversal of 16.9 months. Median post-operative length of stay was 7 days, and 52.1% of patients sustained complications within 30 days post-operatively. Patients reversed within 18 months of stoma formation had fewer significant complications (7.9% v 35.1%, p < 0.001), a shorter length of stay (6 days v 7 days, p < 0.001), and reduced post-operative ileus rates (21.3% v 64.9%, p < 0.001) than those reversed after this period. Receiving adjuvant therapy for malignancy (adjusted Hazard ratio 0.36, 0.17-0.78, p = 0.001) and being male (adjusted Hazard ratio 0.69, 0.49-0.97, p = 0.032) were significantly associated with increased time to reversal.
Emergency stoma formation is commonly performed during EmLap, but the majority of emergency stomas are never reversed. The complication profile for reversing these stomas is significant, but early reversal is associated with better post-operative outcomes. Standards of care for emergency stoma patients would be welcome in order to improve outcomes for this cohort.
对于在紧急情况下造口的患者，恢复肠道连续性是一个关键的考虑因素。关于这些患者造口回纳的结果存在相互矛盾的证据。本研究旨在描述紧急造口术后造口回纳的术后结果，以及这些结果是否受回纳时机的影响。
对2018年至2021年期间4家医院前瞻性维护的急诊剖腹手术（EmLap）数据库进行回顾性分析。确定接受紧急造口术的成年患者，并随访至2024年。最终分析纳入接受造口回纳手术的患者。建立Cox比例风险模型以确定与回纳时间延长相关的因素。
1775例患者接受了急诊剖腹手术，其中505例（28.5%）进行了造口。在这些造口患者中，97例（19.2%）在术后一年内死亡。146例（28.9%）急诊造口患者进行了造口回纳，回纳的中位时间为16.9个月。术后中位住院时间为7天，52.1%的患者在术后30天内出现并发症。与造口形成18个月后回纳的患者相比，造口形成18个月内回纳的患者严重并发症更少（7.9%对35.1%，p<0.001），住院时间更短（6天对7天，p<0.001），术后肠梗阻发生率更低（21.3%对64.9%，p<0.001）。接受恶性肿瘤辅助治疗（调整后风险比0.36，0.17 - 0.78，p = 0.001）和男性（调整后风险比0.69，0.49 - 0.97，p = 0.032）与回纳时间延长显著相关。
急诊剖腹手术期间常进行紧急造口，但大多数紧急造口从未回纳。回纳这些造口的并发症情况较为严重，但早期回纳与更好的术后结果相关。为改善这一队列患者的预后，欢迎制定紧急造口患者的护理标准。
