October 1, 2025Open Access

Early postoperative morbidity and risk stratification in intestinal stoma surgery: A single-center experience

SBShahnawaz BashirMax Super Speciality Hospital YNYawar NazirSher-i-Kashmir Institute of Medical Sciences BWBilal Ahmad WagaySher-i-Kashmir Institute of Medical Sciences

Key Points

Early postoperative complications occurred in 101 (68%) patients, with skin excoriation as the most frequent complication.
Emergency surgery, low serum albumin, and ileostomy formation were identified as independent predictors of complications.
Trainee-led surgeries and malignancy were also significantly associated with increased morbidity after stoma formation.
The study emphasizes the need for specialized stoma care teams for improved early detection and management of postoperative issues.

Abstract

Abstract BACKGROUND: Intestinal stomas remain an essential aspect of surgical practice despite medical technology advances. This study aimed to evaluate the early postoperative morbidity associated with diversion stomas in both elective and emergency settings. MATERIALS AND METHODS: A prospective observational study was conducted over 3 years (June 2020 to May 2023) in the Department of General and Minimal Invasive Surgery. All patients aged >18 years undergoing intestinal stoma formation for benign and malignant conditions were included. Early postoperative complications were recorded and analyzed. RESULTS: A total of 148 patients were included, with 102 (69%) males. The most common procedure was loop ileostomy (105, 71%). Early postoperative complications occurred in 101 (68%) patients, with skin excoriation (53, 36%), mucosal necrosis (31, 21%), and retraction (21, 14%) being the most frequent. Multivariate logistic regression analysis identified emergency surgery (odds ratio OR: 2.6, 95% confidence interval CI: 1.4–4.9, P = 0.002), low serum albumin (<3 g/dL) (OR: 3.1, 95% CI: 1.5–6.3, P = 0.001), and ileostomy formation (OR: 2.8, 95% CI: 1.3–5.7, P = 0.003) as independent predictors of early postoperative complications. Trainee-led surgeries (OR: 2.4, 95% CI: 1.2–4.8, P = 0.009) and malignancy (OR: 2.2, 95% CI: 1.1–4.5, P = 0.025) were also significantly associated with increased morbidity. CONCLUSION: Early postoperative complications following stoma formation remain significant. Ileostomies were associated with higher complication rates than colostomies. Patient factors, surgical expertise, and operative conditions significantly influence outcomes. The development of specialized stoma care teams and early involvement of enterostomal therapists may help in early detection and management of complications. Regular audit of outcomes and complications can identify areas for improvement in surgical technique and perioperative care.

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