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Demographic and Clinical Factors Related to Ostomy Complications and Quality of Life in Veterans With an Ostomy

Pittman, Joyce; Rawl, Susan M.; Schmidt, C. Max; Grant, Marcia; Ko, Clifford Y.; Wendel, Christopher; Krouse, Robert S.

Journal of Wound, Ostomy and Continence Nursing: September-October 2008 - Volume 35 - Issue 5 - p 493–503
doi: 10.1097/01.WON.0000335961.68113.cb

PURPOSE The purpose of this study is to describe demographic, clinical, and quality-of-life variables related to ostomy complications (skin irritation, leakage, and difficulty adjusting to an ostomy) in a veteran population in the United States.

DESIGN The original study employed a descriptive crosssectional study using a mixed method design. This secondary analysis used the quantitative data collected.

SAMPLE AND SETTING Two hundred thirty-nine veterans with intestinal ostomies from 3 Veteran's Administration hospitals participated in the study.

METHODS Instruments used for this investigation included the City of Hope Quality of Life: Ostomy Instrument. Demographic and medical history data were collected from the survey, the Veteran's Administration health information system, and the Tumor Registry database. A self-administered survey questionnaire (mCOH-QOL-Ostomy) was mailed to each participant.

RESULTS The severity of skin irritation, problems with leakage, and difficulty adjusting were significantly related to demographic, clinical, and quality-of-life domains. Univariate analyses showed that age, income, employment, preoperative care (stoma site marking and education), having a partner, ostomy type, reason for ostomy, time since surgery, total quality-of-life scores and scores on all 4 domains of quality of life were related to the severity of these ostomy complications. Age was inversely related to severity of all 3 ostomy complications (skin irritation, leakage, and difficulty adjusting). Having an ileostomy, rather than a colostomy, was associated with higher severity of skin irritation. Having had the stoma site marked preoperatively was associated with less difficulty adjusting to an ostomy, and having had preoperative ostomy education was associated with less severe problems with skin irritation and leakage. Severity of each ostomy complication predicted total quality-of-life scores. Difficulty adjusting to the ostomy was related to all 4 quality-of-life domains (physical, psychological, social, and spiritual).

CONCLUSIONS This study found important relationships between demographic and clinical factors and ostomy complications. Skin problems, leakage, and difficulty adjusting predicted total quality of life scores and domains. Establishing relationships among ostomy complications and demographic, clinical factors, and quality of life can enhance identification of patients at risk for the development of complications and is an important first step in identifying the development of effective interventions to reduce the negative impact of complications for people with ostomies. Further study of predictors and outcomes of ostomy complications is needed to improve care.

Joyce Pittman, RN, APRN-BC, CWOCN, doctoral student, School of Nursing, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana; and Family Nurse Practitioner—Wound, Ostomy, Continence Team, Clarian Health System-Methodist Hospital, Indianapolis, Indiana.

Susan M. Rawl, PhD, RN, Associate Professor, School of Nursing, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana.

C. Max Schmidt, MD, PhD, Staff General Surgeon, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; and Assistant Professor, Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana.

Marcia Grant, RN, DNSc, FAAN, Director, Department of Nursing Research and Education, City of Hope National Medical Center and Beckman Research, Durante, California.

Clifford Y. Ko, MD, Staff Colorectal Surgeon, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Professor, University of California Los Angles.

Christopher Wendel, MS, Biostatistician, Research Service Line, Southern Arizona VA Healthcare System, Tucson, Arizona.

Robert S. Krouse, MD, Staff General and Oncologic Surgeon, Southern Arizona VA Healthcare System, Tucson; and Associate Professor, University of Arizona, Tucson.

Corresponding author: Joyce Pittman, RN, APRN-BC, CWOCN, 1701 Senate Blvd., B250, Clarian Health-Methodist, Indianapolis, IN 46206 (

Copyright © 2008 by the Wound, Ostomy and Continence Nurses Society