From formation to closure: aggregate morbidity and mortality associated with defunctioning loop ileostomies

Background — Defunctioning loop ileostomies are used commonly but there are significant morbidities.

Objective — To describe morbidity and mortality associated with formation and closure of defunctioning loop ileostomies.

Design — Descriptive study based on electronic health records and claims data.

Settings — Academic and community hospitals in Ontario, Canada.

Patients — Adults patients that had a low anterior resection with concurrent defunctioning loop ileostomy from 2002-2014.

Main Outcome Measures — Outcomes of interest included 30-day major complications, acute kidney injury, transfusion, and deep space infection. Rate of ileostomy reversal and percentage of permanent ostomies were also collected.

Results — The cohort consists of 4,658 patients who underwent low anterior resection with concurrent defunctioning loop ileostomy. Thirty-day, 90- day, and 1-year mortality of these patients were 1.2%, 2.2%, and 5.1%, respectively. The rate of reoperation was 5.5%, hospital readmission was 13.4%, major complication was 28.5%, deep organ/space infection requiring percutaneous intervention was 5.2%, acute kidney injury requiring hospitalization was 10.4%. Eighty-six percent had their ileostomy reversed, leaving 13.2% with a permanent ostomy. After ileostomy reversal, 30-day and 90-day mortality was 0.6% and 0.9%, respectively. The rate of major complications was 10.3%, bowel obstruction 7%, ventral hernia 10.5%, deep space infection 1.7%, and repeat operation 2.3%.

Limitations — This study is based on electronic health records and claims data and thus the accuracy of results are dependent on accuracy of data administration which can be variable across institutions.

Conclusions — Morbidity and mortality of defunctioning loop ileostomies are significant. One in 8 patients will have a permanent ostomy.