Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study
Abstract Background 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 r...
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BMC
2025-03-01
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| Series: | World Journal of Emergency Surgery |
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| Online Access: | https://doi.org/10.1186/s13017-025-00598-3 |
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| author | Scott MacDonald Anna Gallagher Lauren McNicholl Luke McElroy Rebecca Hughes Tara Quasim Susan Moug |
| author_facet | Scott MacDonald Anna Gallagher Lauren McNicholl Luke McElroy Rebecca Hughes Tara Quasim Susan Moug |
| author_sort | Scott MacDonald |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusion 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. |
| format | Article |
| id | doaj-art-3b01efd3f551476cb5ae2b0df43c846f |
| institution | DOAJ |
| issn | 1749-7922 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj-art-3b01efd3f551476cb5ae2b0df43c846f2025-08-20T02:49:26ZengBMCWorld Journal of Emergency Surgery1749-79222025-03-0120111210.1186/s13017-025-00598-3Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort studyScott MacDonald0Anna Gallagher1Lauren McNicholl2Luke McElroy3Rebecca Hughes4Tara Quasim5Susan Moug6Department of Surgery, Royal Alexandra HospitalDepartment of Surgery, Royal Alexandra HospitalDepartment of Surgery, Royal Alexandra HospitalDepartment of Surgery, Royal Alexandra HospitalDepartment of Surgery, Golden Jubilee University National HospitalDepartment of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow Royal InfirmaryDepartment of Surgery, Royal Alexandra HospitalAbstract Background 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. Methods 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. Results 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. Conclusion 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.https://doi.org/10.1186/s13017-025-00598-3EmergencyStomaReversalComplicationsIleostomyColostomy |
| spellingShingle | Scott MacDonald Anna Gallagher Lauren McNicholl Luke McElroy Rebecca Hughes Tara Quasim Susan Moug Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study World Journal of Emergency Surgery Emergency Stoma Reversal Complications Ileostomy Colostomy |
| title | Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study |
| title_full | Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study |
| title_fullStr | Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study |
| title_full_unstemmed | Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study |
| title_short | Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study |
| title_sort | stoma reversal after emergency stoma formation the importance of timing a multi centre retrospective cohort study |
| topic | Emergency Stoma Reversal Complications Ileostomy Colostomy |
| url | https://doi.org/10.1186/s13017-025-00598-3 |
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