We’ve just done an analysis of overall complications between patients with stomas and patients without. For this, we took National Surgical Quality Improvement Program (NSQIP) data and compared outcomes for patients with stomas against those without. This sort of data is unique. It is a database of hundreds of thousands of patients across the USA and helps to identify trends in outcomes. Moreover, it allows comparison of patients without the influence of institutional bias and gives you a picture of the state of health and outcomes on a national level.
There is a lot of data to go through. The database lists surgical procedures by CPT code, and we can identify the codes that include formation of ostomies. We can also identify emergency and elective surgery codes which help us understand the difference in outcomes between the two. There were just over 65,000* patients who underwent a colorectal surgical procedure resulting in an ileostomy or colostomy between 2005-2016. This was compared to almost 250,000 patients who underwent a colorectal surgical procedure that did not result in a stoma being made. The data matched well for age, sex, BMI, smoking status, diabetes etc.
The results displayed readmission rates and post-operative complications were higher in ostomates across the board.
Unplanned readmission rates for things like surgical site infections, dehydration, acute kidney injury, and wound disruptions were significantly higher for patients with stomas.
There are lots of reasons why this could be. For example, patients with active inflammatory bowel disease may have compromised nutrition and therefore poorer wound healing that results in wound infections. Patients who have had bowel resections have issues with fluid management and bowel motility which can result in dehydration.
We need to do something to attempt to improve these outcomes for ostomates, and we believe that the smart connected technology we have in our smart ostomy bags is the answer. We’ve already demonstrated improved quality of life for patients who used the simple but ingenious Ostomy alert bag fill sensor. We now have the capability to measure electrolyte profiles in stoma waste and peri-stomal skin temperature trends in real time to predict problems before they become serious. The goal is to reduce unplanned readmission rates and improve the overall health and quality of life of Ostomates.
Wouldn’t it be great for the NSQIP data to show equivalent outcomes for ostomates and non-ostomates in a few years? We’re working hard to try and make this a reality.
*A note on NSQIP data:
Not every hospital in the USA contributes their results to the database as it is voluntary. We know that there is evidence that up 150,000 new stoma’s per year are made in the US so the figure of 65,000 will seem low. Nevertheless, it is an extremely large group of patients and certainly useful for understanding how outcomes change over time.
Dr. Saahil Mehta MD FRCS
Dr. Saahil Mehta is a Plastic Surgeon in the UK, and his research interest involves skin healing and heat therapy. He is currently working as Clinical Director and Innovation Lead at 11 Health Technologies in California to understand the relationship between skin health and temperature.