Early peristomal complications: detailed analysis, classification and predictive risk factors.

Introduction: Peristomal complications are frequently neglected by surgeons. Our aim was to assess peristomal complications occurring within 30 days after surgery and identify predictive risk factors.

Methods: All patients who underwent stoma creation from January 2014 to June 2016 in our institution were included unless patients who died, had their stoma reversed or were lost to follow-up. Peristomal complications were retrospectively analysed using a photography database, a validated scale for peristomal skin lesions and the Clavien-Dindo score. Peristomal complications were categorized as absent, mild or relevant. Univariate and multivariate analysis were performed to identify risk factors for a) incidence of and b) persistence of relevant peristomal complications at 30 postoperative days.

Results: 111 patients were included, 16 (14%) patients had mild and 65 (59%) patients had relevant complications. The most common event was mucocutaneous separation in 57 (51%) patients. Complications were still present at 30 days in 36 (32%) patients. Double-barrel (vs end stoma) was an independent risk factor for significant morbidity (OR=2.394 (95%CI=1.082-5.293), p=0.030). Persistence of relevant complications at 30 days was more likely associated to urgent surgery (OR=4.239 (95%CI=1.105-16.257), p=0.035) and to ASA score III/IV (OR=5.963 (95%CI=1.447-24.569), p=0.013). Male sex (OR=0.246 (95%CI=0.069-0.874), p=0.030) and age over 70 years (OR=0.121 (95%CI=0.029-0.515), p=0.004) appeared to be protective.

Conclusions: Early peristomal complications are common, usually mild. They are most likely to persist beyond 30 days in patients operated as emergencies and with an ASA score of III-IV.

Key Words: Complications, Complications, Stoma, Mucocutaneous separation.