Individual surgeon practice is the most important factor influencing diverting loop ileostomy creation for patients undergoing sigmoid colectomy for diverticulitis - 24/04/18
Abstract |
Background |
To identify factors associated with diverting ileostomy creation (DLI) in patients undergoing sigmoid colectomy for diverticular disease in a high volume colorectal unit and to obtain information for better preoperative patient counseling.
Methods |
Patients who underwent sigmoid colectomy with colorectal anastomosis with or without DLI for diverticulitis between 01/1994-12/2014 were identified. Preoperative characteristics, surgeon practice year, individual surgeon and postoperative outcomes were compared between patients with DLI or not.
Results |
1320 patients were identified and DLI was created in 204 (15.4%) patients. DLI creation was associated with older age (p < 0.001), female gender (p = 0.01), higher ASA-class (p < 0.001), hypertension (p = 0.01), DM(p < 0.001), renal comorbidities (p < 0.001), preoperative steroid use (p = 0.03), preoperative anemia (p = 0.004), and open surgery (p < 0.001). While ileostomy creation rates did not vary over the years during the study period or with increased surgeons' experience, surgeon identity had significant impact on ileostomy creation (Rate range 6.8–60.7%, p < 0.001). Multivariate logistic regression analysis revealed that individual surgeon, open approach, preoperative steroid use, and disease-related factors remained independently associated with DLI creation.
Conclusion |
Individual surgeon's practice affects the rate of diverting ileostomy creation in patients undergoing sigmoid colectomy for diverticular disease.
Le texte complet de cet article est disponible en PDF.Highlights |
• | 1320 patients whom operated by 29 surgeons were identified during study period and DLI was created in 204(15.4%) patients. |
• | Multivariate analysis revealed individual surgeon, open surgery, abscess, stricture and phlegmon is associated with DLI. |
• | Surgeon practice, open surgery, steroid use and inherent disease-related factors were associated with DLI in decision making. |
• | DLI after sigmoidectomy for diverticulitismay be associated with increased length of stay and renal morbidities. |
• | Surgeon practice is a contributory factor influencing rate of DLI for patients undergoing sigmoidectomy for diverticulitis. |
Keywords : Ileostomy, Diverticulitis, Surgeon, Morbidity
Plan
Vol 215 - N° 3
P. 442-445 - mars 2018 Retour au numéro
Article précédent
- Discussion of: Outcomes of rectal resection following neoadjuvant therapy in the elderly: Can rectal cancer patients be too old for a neoadjuvant approach?
- Discussion of: Individual surgeon practice is the most important factor influencing diverting ileostomy creation for patients undergoing sigmoid colectomy for diverticulitis
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