Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis

Abstract

Objective

The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor.

Methods

A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS).

Results

Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75–6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%.

Conclusions

The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.

Keywords:

• Complications
• meta-analysis
• incidence
• risk factors
• systematic review
• stoma

Transparency

Declaration of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

FD, RC, CA, conceptualized the study. RC and FD performed the statistical analysis. LB, NSU, GV, SR, IV, IB, CD, TN, and DFM significantly contributed to the systematic review by managing the retrieved literature. FD and RC drafted the original manuscript, and all authors assisted in writing and reviewing the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Authors gratefully thank the board of the “Associazione Italiana Operatori Sanitari di Stomaterapia” (AIOSS) for having appreciated the research, and we also thank the board of the Italian Association of Cancer Nurses (AIIAO) for having provided hints for this study.