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Comparison Of Surgical Outcomes For Colostomy Closure Performed By Acute Care And A Dedicated Colorectal Service
*Marc O. Duverseau1, *Jesse Sulzer2, *Andrew M O'Neill1, *Cyan McFarlane1, *Michael J Schurr1, *Colin Bird2, Joseph F Buell2
1Mountain Area Health Education Center (MAHEC), Asheville, NC;2Mission Hospital and HCA Healthcare, Asheville, NC

Objective: Colostomy closure remains a highly morbid procedure with nearly 50% of end stomas never being reversed. Previous literature suggests the complication rate is as high as 25% including surgical site infections and anastomotic failures. With the creation of a colorectal service (CS) the performance of colostomy reversal has been transferred from the acute care service. This study analyzes the differences for colostomy closures performed by CS compared to ACS. Methods: We retrospectively evaluated our experience of 127 colostomy closures performed in our multi-institutional hospital system by ACS and CS from 2016 and 2020. Demographic data, operative data, and outcomes such as abscess, leak and readmission were analyzed with regression analysis performed for leak. Results: 71 procedures were performed by CS (56%) and 56 by ACS (43%). The majority of colostomy reversals was after Hartmanís procedure for perforated diverticulitis. No differences in demographics were identified. Two (3.6%) ACS patients required the management of the CS for definitive repair. Regression analysis identified BMI (2.43; p=0.001), Male gender (-2.39; p=0.18) and CS (-2.28; p=0.025) were significant.

ServiceAge (years)Male GenderBMIDMSmokerLOS (days)SSIAbscessLeak30-day readmission
CS n=7159.055%29.121%76%5.2710%3%1%10%
ACS n=5658.059%29.413%70%5.4523%13%11%21%
p-value0.7090.6550.8510.2050.4220.6730.0410.0350.0220.070

Conclusion: Analysis of the current dataset identified increased BMI and female gender were patient demographics that portended increased risk for leak. Our study also identified that colostomy reversals performed by a dedicated colorectal service improved outcomes including lower rates of surgical site infection, abscess and anastomotic leak.


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