Outcome and Timing of Ostomy Reversal Surgery for Diverticular Disease in Veterans Administration Hospitals

• Published in: The American surgeon 2023-04, Vol.89 (4), p.656-664
• Main Authors: Napolitano, Michael A., Holleran, Timothy J., Sparks, Andrew D., Zimmermann, Jason, Brody, Fredrick J., Duncan, James E.
• Format: Article
• Language: English
• Subjects: Ascites; Body mass index; Chronic obstructive pulmonary disease; Classification; Codes; Colectomy - adverse effects; Colostomy - adverse effects; Comorbidity; Complications; Demographics; Diverticular Diseases - complications; Diverticulitis; Drug use; Elective surgery; Heart failure; Heart surgery; Hospitals; Humans; Hypertension; Ileostomy; Kidney diseases; Laparoscopy; Medical personnel; Ostomy; Ostomy - adverse effects; Patients; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Quality control; Quality improvement; Radiation therapy; Retrospective Studies; Sleep apnea; Steroids; Surgery; Surgical site infections; United States; United States Department of Veterans Affairs; Variables; Vein & artery diseases; Veterans
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/00031348211034764

Background Veterans undergoing elective surgery for diverticular disease have an ostomy creation rate of 18%. The purpose of this study was to analyze the outcomes and timing of ostomy reversal surgery, perioperative complications, and differences between colostomy and ileostomy reversal outcomes. Methods A retrospective review of the Veterans Affairs Surgical Quality Improvement Project (VASQIP) database was performed. Patients undergoing elective colectomy for diverticular disease between 2004 and 2018 were identified. Demographics, comorbidities, ostomy type, time to reversal, and postoperative complications were analyzed. Results 4,198 patients underwent elective colectomy for diverticular disease, with 751 patients (17.9%) receiving an ostomy. Of patients who received an ostomy, 407 had ostomy reversal surgery within the Veterans Health Administration system (54.2%), with 243 colostomies, 149 ileostomies, and 15 unspecified. Median time to ostomy reversal was 5.0 months (interquartile range 3.2, 7.8). Complication rate after reversal was 23.1%; surgical site infection was most common (9.1%). Patients with American Society of Anesthesiologists classification >3 (adjusted odds ratio (aOR) = .40[.22-.72]), increasing age (aOR = .98[.97-.99]), laparoscopic index procedure (aOR = .42[.27-.63]), and hypertension (aOR = .63[.46-.87]) were less likely to have their ostomy reversed. There were no differences in postoperative complication rates after ostomy vs ileostomy reversals. Reversals after 4.6 months were associated with 3.4-times higher odds of complications. Conclusion Ostomy creation and reversal rates are similar between the veteran and non-veteran populations in the United States. Delays in reversal surgery were associated with worse postoperative outcomes, which underscore the importance of close follow-up for patients with an ostomy after elective colectomy for diverticular disease.