Effect of closed and permanent stoma on disease course, psychological well-being and working capacity in Swiss IBD cohort study patients

Abstract

Background: Little is known about the impact of ostomy formation in inflammatory bowel disease patients on course of disease, psychological well-being, quality of life and working capacity.

Methods: We analyzed patients over a follow-up of up to 16 years in the Swiss inflammatory bowel disease cohort study (SIBDCS) with prospective data collection. We compared Ulcerative colitis and Crohn's disease patients with and without ostomy as well as permanent and closed stoma formation before and after surgery, investigating disease activity, psychological wellbeing and working capacity in a case-control design.

Results: Of 3825 SIBDCS patients, 176 with ostomy were included in the study and matched with 176 patients without ostomy using propensity score, equaling 352 patients for the analysis. As expected, we observed a lower mean and maximal disease activity in patients after stoma surgery compared with control patients without stoma. Overall, psychological wellbeing in patients with stomas vs. controls as well as patients with permanent vs. closed stoma was similar in terms of disease-specific quality of life (total score of the Inflammatory Bowel Disease Quality of Life questionnaire), psychological distress (total score of the Hospital Anxiety and Depression Scale), and stress at work (effort-reward-imbalance ratio), with the exception of a higher Posttraumatic Diagnostic Scale total score in patient with vs. without stoma. Compared to IBD patients without stoma, the adverse impact on working capacity in overall stoma IBD patients appeared to be modest. However we observe a significantly higher reduction in working capacity in permanent vs. closed stoma in CD but not UC patients.

Conclusion: As to be expected, IBD patients may benefit from closed and permanent stoma application. Stoma surgery appears to only modestly impact working capacity. Importantly, stoma surgery was not associated with adverse psychological outcomes, with comparable psychological well-being regardless of presence and type of stoma.

Fig 1. Comparison of mean and maximal Crohn’s Disease Activity Index (CDAI) and Modified Truelove and Witts Activity Index (MTWAI) in patients with and without stoma.

Fig 2. Mean and maximal disease activity in permanent vs. closed stoma in patients with Crohn’s Disease and patients with Ulcerative colitis.

Fig 3. Comparison of different psychological scores to assess wellbeing of IBD patients.

A) Comparison of median and minimal and maximal scores of Inflammatory Bowel Disease Quality of Life Questionnaire Total Score (IBDQ Total Score) in different patient groups as an indicator of health related quality of life. B) Comparison of median and minimal and maximal scores of Hospital Anxiety and Depression Scale (HADS) Total Score in different patient groups as an indicator of anxiety. C) Comparison of median and minimal and maximal scores of Posttraumatic Diagnostic Scale (PDS) Total Score in different patient groups as an indicator of Post-Traumatic Stress Disorder. D) Comparison of median and minimal and maximal scores of Effort-Reward Ratio in different patient groups.

Fig 4. Working capacity and invalidity pension related data in different groups.

A) Working patients in different patient groups. B) Number of patients in different groups absent from work at least once during participation in the Swiss Inflammatory Bowel Disease Cohort Study. C) Patients in different groups with disability benefits.