A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network

Abstract

Aim: The study aimed to identify the incidence of early stoma problems after surgery for colorectal cancer to identify predisposing factors and to assess the effect on discharge from hospital and the greater need for community stoma care.

Method: A prospective study of 192 patients was carried out over a six-month period in the 13 units of the Greater Manchester and Cheshire Cancer Network. Stoma problems were categorized into fistula, leakage, pancaking, necrosis, retraction, separation, stenosis, skin problems, parastomal hernia, suboptimal stoma site and need for resiting or refashioning. Differences in incidence between units (anonymized) were analysed, and the effect of stoma complications on length of hospital stay and the need for additional community stoma care was determined.

Results: One hundred and ninety-two patients with stomas were included, of which 52 (27.1%) were identified as being problematic (range 0-66.7% between units). Significant risk factors included stoma type (colostomy) (P < 0.05), short stoma length (P = 0.006), higher BMI (P = 0.043), emergency surgery (P = 0.002) and lack of preoperative site marking (P < 0.001). Problematic stomas were associated with longer hospital stay (P < 0.001) and increased community care (P < 0.001).

Conclusion: Stoma type, stoma length, body mass index, emergency surgery and lack of preoperative marking were significant risk factors. Overall complication rates compare favourably with other studies.