Morbidity and Mortality Following Intestinal Ostomy Surgery: A 16-Month Prospective Cohort Study

Background and objectivesIntestinal stomas are widely practised in cases of various gastrointestinal emergencies and in selected elective procedures.Nevertheless, the morbidity and mortality of stoma patients are high in low-and middle-income environments.This study assessed the pattern of complications and short-term outcomes after stoma creation in a tertiary centre in central India.It also explored factors associated with poor outcomes in adult and paediatric patients. MethodsThis prospective observational cohort study was conducted at All India Institute of Medical Sciences (AIIMS) Bhopal between September 1, 2023 and December 31, 2024.Ninety-eight consecutive patients who underwent intestinal stoma creation were enrolled.Structured proformas were used to record demographic variables, clinical status, operative details and postoperative complications.Follow-up was conducted at 15 days, one month and six months to broadly evaluate the early (≤30 days) and late (>30 days to six months) complications.Statistical tests included the chi-square or Fisher's exact test, t-test and Mann-Whitney U test (P < 0.05); unadjusted odds ratios (ORs) were calculated with 30-day death as the outcome. ResultsThe majority of procedures were performed in an emergency (82.7%), with the most common type being ileostomy (66.3%).In 75.5% of patients, early complications occurred, with the most frequent ones being peristomal skin excoriation (49.0%) and wound infection (24.5%), and high-output stoma occurred in 11 patients (11.2%), all after emergency surgery.The total 30-day mortality was 21.4%.On unadjusted analysis, preoperative combined shock and sepsis (OR 39.3, 95% CI 8.2-187.3)and deranged renal function (OR 22.9, 95% CI 6.0-87.4)were strongly associated with 30-day mortality; all 21 deaths occurred among patients who required postoperative ICU care.Among the 77 patients alive at 30 days, late complications occurred in 11 (14.3%),mainly parastomal hernia (7.8%) and stoma prolapse (6.5%). ConclusionsEmergency stoma creation was associated with high early morbidity and 30-day mortality, concentrated in physiologically compromised patients.Outcomes may be improved by optimising resuscitation and early control of sepsis, as well as increased postoperative monitoring.Also, protocolised management of high stoma output and dehydration, and better access to structured stoma-care services.