Incidence of intestinal stoma related complications and risk factors among patients in Uganda

Abstract

The creation of intestinal stomas for diversion of enteric contents is an important component of the surgical management of several surgical gastro-intestinal diseases. Complications of stoma surgery remain common, and can lead to significant increase in the cost of health care, psychological impact to patient’s body image, self-esteem, and significant morbidity. Objective: To evaluate the incidence and risk factors of intestinal stoma related complications among patients following stoma placement at two large hospitals in Uganda. Method: A prospective cohort study, patients with intestinal stomas from Mulago National Referral Hospital and St Mary’s Hospital Lacor were followed for 30 days postoperatively between May 2023 and July 2023. Ethical approval to conduct the study was obtained from relevant authorities before commencement. Results: We recruited and followed up 100 patients following stoma placement at MNRH and Lacor Hospitals. The age at diagnosis ranged from 1 day to 87 years. The median age was =19.5years (IQR=0.68-45) and the majority, 71% were males with a M: F ratio of 1.4:1. Congenital anomalies were the main indications for intestinal stomas in children accounting for (35%) while bowel perforations 38%, and diversion stoma due to malignancy (colorectal cancer) 27% were the main indications in adults. Overall incidence rate of stoma related complications was 61.1% and cumulative incidence of 9 per100 person week, the most common complication observed in this study was peristomal dermatitis (34.4%), and stoma prolapse 27.9%. The risk of developing this complication was higher in males than females with a confidence interval of 95% (p-value 0.027) and risk in re-operated patient’s p-value 0.021. Conclusion: Intestinal stoma surgeries performed at MNRH and Lacor Hospital are associated with various complications which are a burden to patients. The insights observed in this study may apply to other general and district hospitals. We recommend, patient and family education be of paramount importance to prevent problems of dermatitis.