Short-term outcome of diverting loop ileostomy reversals performed by residents: a retrospective cohort prognostic factor study

International Journal of Colorectal Disease · 6 authors, 4 centres

AI SUMMARY

FIDELITY 100%

POPULATION300 patients undergoing diverting loop ileostomy reversal

INTERVENTIONSurgical reversal performed by surgical trainees

COMPARISONSurgical reversal performed by attending surgeons

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AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This retrospective cohort study compared outcomes for 300 patients undergoing diverting loop ileostomy reversal by surgical trainees versus attending surgeons. It found that while trainees had significantly longer operation times, the surgeon's training level was not a risk factor for postoperative morbidity; instead, a delayed first bowel movement was a significant risk factor for surgical site infections.

Full summary

535 CHARS

This retrospective cohort study analyzed 300 cases of diverting loop ileostomy reversal at a single center to compare outcomes based on the surgeon's level of training. The primary outcome was postoperative morbidity classified by the Clavien-Dindo system, and the secondary outcome was intestinal motility dysfunction. Key risk factors identified were an elevated BMI and a delayed first bowel movement (later than 3 days post-surgery) for surgical site infections, and a primary malignant disease for intestinal motility dysfunction.

PICO

PPOPULATION

300 patients undergoing diverting loop ileostomy reversal

IINTERVENTION

Surgical reversal performed by surgical trainees

OOUTCOME

Postoperative morbidity (Clavien-Dindo classification) and postoperative intestinal motility dysfunction

STUDY TYPE

cohort

SPECIALTY

surgery

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10121496

Short-term outcome of diverting loop ileostomy reversals performed by residents: a retrospective cohort prognostic factor study

International Journal of Colorectal Disease

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ABSTRACT

Aim The reversal of diverting loop ileostomy (DLI) is one of surgical trainees’ first procedures. Complications of DLI reversal can cause life-threatening complications and increase patient morbidity. This study compared DLI reversals performed by surgical trainees with those by attending surgeons. Method This retrospective cohort study was performed at a single primary care center on 300 patients undergoing DLI reversal. The primary outcome was morbidity, according to the Clavien-Dindo classification (CDC), with special attention paid to the surgeon’s level of training. The secondary endpoint was postoperative intestinal motility dysfunction. Results Surgical trainees had significantly longer operation times ( p < 0.001) than attending surgeons. Univariate analyses revealed no influence on the level of training for postoperative morbidity. First bowel movement later than 3 days after surgery was a significant risk factor for CDC \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\ge$$\end{document} ≥ 3 (OR, 4.348; 96% CI, 1670–11.321; p = 0.003). Independent risk factors for surgical site infections (SSIs) were an elevated BMI (OR, 1.162; 95% CI, 1.043–1.1294; p = 0.007) and a delayed bowel movement (OR, 3.973; 95% CI, 1.300–12.138; p = 0.015). For postoperative intestinal motility dysfunction, an independent risk factor was a primary malignant disease (OR, 1.980; 95% CI, 1.120–3.500; p = 0.019), and side-to-side stapled anastomosis was a protective factor (OR, 0.337; 95% CI 0.155–0.733; p = 0.006). Conclusion Even though surgical trainees needed significantly more time to perform the surgery, the level of surgical training was not a risk factor for increased postoperative morbidity. Instead, delayed first bowel movement was predictive of SSI. Supplementary Information The online version contains supplementary material available at 10.1007/s00384-023-04390-0.

CITATION EXPORT

Clara von Savigny, Mazen A. Juratli, Christine Koch et al.. Short-term outcome of diverting loop ileostomy reversals performed by residents: a retrospective cohort prognostic factor study. International Journal of Colorectal Disease. (2023). https://doi.org/10.1007/s00384-023-04390-0

AUTHORS

6 · 4 CENTRES

Clara von Savigny, Mazen A. Juratli, Christine Koch, Tatjana Gruber-Rouh, Wolf O. Bechstein, Teresa Schreckenbach

1https://ror.org/04cvxnb49grid.7839.50000 0004 1936 9721Department of General, Visceral, Transplantation, and Thoracic Surgery, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany
2https://ror.org/01856cw59grid.16149.3b0000 0004 0551 4246Department of General, Visceral and Transplant Surgery, Muenster University Hospital, Muenster, Germany
3https://ror.org/04cvxnb49grid.7839.50000 0004 1936 9721Department of Internal Medicine, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany
4https://ror.org/04cvxnb49grid.7839.50000 0004 1936 9721Institute of Diagnostical and Interventional Radiology, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany