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Patient-Reported Outcome After Ostomy Surgery for Chronic Constipation

Iqbal, Fareed; van der Ploeg, Valerie; Adaba, Franklin; Askari, Alan; Murphy, Jamie; Nicholls, R. John; Vaizey, Carolynne

Journal of Wound Ostomy & Continence Nursing: July/August 2018 - Volume 45 - Issue 4 - p 319–325
doi: 10.1097/WON.0000000000000445
Ostomy Care

PURPOSE: The purpose of this study was to describe experiences of and evaluate psychosocial and health-related quality of life of individuals undergoing ostomy surgery for severe, chronic constipation.

METHODS: A search of the local ostomy archive and the electronic hospital episode statistics database was performed in a large tertiary referral center. Study outcomes were evaluated retrospectively using clinical notes and prospectively via administration of the City of Hope Ostomy Quality of Life questionnaire, Medical Outcomes Study Short Form-36, Hospital Anxiety and Depression tool, and a specially designed ostomy-specific questionnaire. Questionnaires were mailed and returned via post.

RESULTS: Twenty-four patients, with a median age of 44 years (interquartile range [IQR] = 31-56), who underwent ileostomy (n = 20) and colostomy (n = 4) over a 13-year period participated in the study. The vast majority of respondents (91%; n = 22) were female. Ten (41%) underwent laparoscopic surgery, 13 (54%) underwent open procedures, and 1 was converted from laparoscopic to open surgery. The mean length of stay (5.5 days vs 5.4 days) and the rate of complication did not differ between the 2 approaches. Fourteen patients (13 females, median age = 47.5 years; IQR = 23-70 years) responded to the postal questionnaires (58.3%). Adverse effects on health-related quality of life in the physical and social well-being domains were reported, and a further 86% of respondents reported psychological morbidity related to their ostomy. However, more than 70% were satisfied (median follow-up = 17 months; IQR = 0.16-8 years) with their quality of life despite a 20% reoperation rate.

CONCLUSIONS: An ostomy is a justified last-resort treatment option in selected individuals with severe, chronic constipation. Patients should be warned of the negative effects on health-related quality of life and the risk of complications. We advocate using an algorithm presented in this article.

Fareed Iqbal, MBChB, BMedSci (Hons), MRCS (Eng), Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England.

Valerie Van der Ploeg, MSc, Sir Alan Department of Physiology, St Mark's Hospital, London, England.

Franklin Adaba, MRCS (Eng), MBBS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England.

Alan Askari, MBChB, MRCS (Eng), Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital, London, England.

Jamie Murphy, PhD, MB ChirB, FRCS, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Paddington, London, England.

R. John Nicholls, MS, FRCS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England.

Carolynne Vaizey, MBBS, FCS, FRCS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England.

Correspondence: Fareed Iqbal, MBChB, BMedSci (Hons), MRCS (Eng), Sir Alan Park's Department of Physiology, 4th Floor, St Mark's Hospital, London, England (Fareed.iqbal@nhs.net).

© 2018 by the Wound, Ostomy and Continence Nurses Society.