Major stoma complications in pediatric patients in a tertiary hospital in a low–middle-income country: a retrospective cohort study
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In brief
In brief
This retrospective study from the Philippines examined major stoma complications in 1,041 pediatric patients over 5 years, finding a 9.8% complication rate with ileostomies showing highest risk. Stomal prolapse and adhesive bowel obstruction were most common, typically occurring within the first year post-creation.
- Major stoma complications occurred in 9.8% of pediatric patients, with 1.3% mortality directly attributed to stoma issues over 5 years.
- Ileostomies had significantly higher rates of major complications compared to other stoma types in this pediatric cohort.
- Stomal prolapse and adhesive bowel obstruction were the most common complications requiring surgical intervention.
- Nearly half of major stoma complications presented within the first year post-creation, with median time of 14 months.
- Neonates with congenital conditions (anorectal malformation, Hirschsprung's disease) comprised the largest patient group with complications.
Written by the GCMD Library team from the article.
Abstract
Introduction
Intestinal stomas are one of the most common parts of pediatric surgical care, and complications arising from it have significant impact on overall patient outcomes. However, data on major complications in low–middle-income countries remain limited. This pilot retrospective cohort study aimed to investigate the prevalence, types, and management of major stoma complications in pediatric patients at a tertiary government hospital in the Philippines.
Methods
Medical records of pediatric patients with major stoma complications classified as Clavien–Dindo III–V from June 2018 to June 2023 were reviewed. Patient-related factors (age, sex, diagnosis) and surgery-related factors (stoma type and location, surgeon expertise) were analyzed. Descriptive statistics characterized demographic profiles, while Chi-square and t tests analyzed categorical and continuous variables, respectively. Multivariable logistic regression evaluated independent associations with major stoma complications.
Results
Out of 1041 pediatric patients with stomas, 102 cases had major complications, representing a prevalence rate of 9.8%. Mortality directly attributed to stoma complications accounted for 1.3% of the total cases, or 14 deaths in 5 years. Neonates comprised a significant portion, primarily diagnosed with congenital conditions like anorectal malformation and Hirschsprung’s disease. Ileostomies exhibited a higher incidence of major complications compared to other stoma types. Stomal prolapse and adhesive bowel obstruction are the most common reported stoma complications requiring surgical intervention while stoma revision is the most frequent corrective procedure. The median time from stoma creation to presentation of major complication was 14 months, with nearly half of the complications occurring within the first year. Only the presence of ileostomy had significant association with the development of major complications among the risk factors analyzed.
Conclusions
This study provides useful insights into stoma complications in pediatric patients in a low–middle income country. Despite the lack of significant associations between the patient-related and surgeon-related factors, and major stoma complications, further investigation into other contributing factors is warranted. Improvements in data collection methods and prospective studies with larger sample sizes are recommended to enhance understanding and optimize care of major stoma complications. Addressing the challenges identified in this study could lead to a comprehensive and tailored approach to pediatric stoma care and their complications.