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Stoma Bridge Types and Their Impact on Patient Outcomes

A Retrospective Analysis and Prospective Global Survey of Surgical Practice

McTigue, Toni; Lei, Jason; Kowalski, Mildred Ortu; Prestera, Susan; Chiu, Stephanie; Shehebar, Josef A.

Journal of Wound Ostomy & Continence Nursing: July/August 2019 - Volume 46 - Issue 4 - p 309–313
doi: 10.1097/WON.0000000000000543
Ostomy Care
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PURPOSE: The purpose of this study was to describe the effect of rigid or flexible stoma bridges used for loop ostomy diversions on peristomal skin integrity. Additional aims were to describe surgeon practices related to stoma bridges, and determine the availability of an ostomy nurse specialist.

DESIGN: Retrospective chart review and cross-sectional survey.

SAMPLE AND SETTING: The sample used to address the first aim (effect of stoma bridges) comprised 93 adult patients cared for at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, an acute care facility. Data provided by 355 colorectal surgeons from 30 countries were used to describe surgeon practice in this area and determine the availability of an ostomy nurse specialist. Respondents were invited from an international roster of colorectal surgeons obtained with permission from the American Society of Colon and Rectal Surgeons (ASCRS).

METHODS: In order to accomplish the initial aim, we retrospectively reviewed medical records of patients who underwent ostomy surgery from 2008 to 2015 and met inclusion criteria. In order to meet our additional aims, analyzed data were obtained from a survey of colorectal surgeons that queried practices related to stoma bridges, and availability of an ostomy nurse specialist.

RESULTS: Patients managed with a rigid bridge were significantly more likely to experience leakage beneath the pouching system faceplate than were patients managed by a flexible bridge (42% vs 11%, P < .001). Slightly less than one quarter of patients who developed leakage (n = 22, 24%) experienced pressure and moisture-related peristomal skin complications. Peristomal wounds, inflammation, and infection were significantly higher when a rigid bridge was used (χ2 test, P < .003). The surgeon's survey (N = 355) showed variability in the use of bridges. Ninety-three percent of all surgeons indicated an ostomy nurse specialist was part of their health care team.

CONCLUSIONS: Rigid ostomy bridges were associated with a higher likelihood of leakage from underneath the faceplate of the pouching system and impaired peristomal skin integrity. Analysis of colorectal surgeon responses to a survey indicated no clear consensus related to bridge use in patients undergoing loop ostomies.

Toni McTigue, MSN, APN-C, CWOCN, Atlantic Health System/Morristown Medical Center, Morristown, New Jersey.

Jason Lei, MD, Department of Surgery, Division of Colorectal Surgery, Northwell Health, Bridgewater, New Jersey.

Mildred Ortu Kowalski, PhD, RN, NE-BC, CCRP, Atlantic Health System/Morristown Medical Center, Morristown, New Jersey.

Susan Prestera, MSN, ACNP, Saint Joseph's Medical Center, Paterson, New Jersey.

Stephanie Chiu, MPH, Atlantic Health System, Atlantic Center for Research, Morristown, New Jersey.

Josef A. Shehebar, MD, FACS, FASCRS, Department of Surgery, Division of Colorectal Surgery, New York University-Lutheran Medical Center, Brooklyn, New Jersey.

Correspondence: Toni McTigue, MSN, APN-C, CWOCN, Atlantic Health System/Morristown Medical Center, Wound, Ostomy, and Continence Department, 100 Madison Ave, Box 42, Kahn 1, Morristown, NJ 07960 (toni.mctigue@atlantichealth.org).

© 2019 by the Wound, Ostomy and Continence Nurses Society.