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The objective of this study was to stratify patients for colostomy closure into risk categories according to preoperative variables. This was a retrospective case series. Median follow-up was 82 months. A tertiary care academic medical center was the setting for this study. A study sample of 155 consecutive patients who underwent colostomy closure at a single institution between 1985 and 1995 were included in this study. The following preoperative variables were analyzed: indication for colostomy fashioning; age; gender; American Society of Anesthesiology (ASA) class; presence of cardiac, renal, or pulmonary dysfunctions; presence of diabetes mellitus; and immunosuppression. The occurrence of adverse outcome, as evidenced by postoperative morbidity and mortality, was used as the main outcome measure. Complications occurred in 49 patients (31.6%), including a 1.3 per cent mortality. There was a trend of increasing morbidity with increasing ASA class. The single factor that showed a statistically significant increase in morbidity was the presence of diabetes (P = 0.036). Predicted probabilities of complications for patients with ASA III with renal disease was 31 per cent, increased to 47.9 per cent if cardiac disease was also present and to 77 per cent with the addition of diabetes. The presence of diabetes carries an independent risk factor for adverse outcome in colostomy closure. This study provides information about stratification of postoperative risk based on commonly available preoperative variables. In the majority of cases, colostomy closure seems to carry a very acceptable complication rate. In selected patients with multiple preoperative risk factors, the morbidity becomes significantly higher.
DIVERSION OF THE fecal stream through a temporary colostomy is still a common procedure in the armamentarium of surgeons and represents the most prudent choice in several emergency conditions. Certain technical alternatives, such as subtotal colectomy, endoluminal devices, or intraoperative colonic lavage, can sometimes allow primary anastomosis without creating a stoma. In selected clinical situations, avoidance of colostomy is possible by careful timing of medical and surgical management (e.g., percutaneous drainage of peridiverticular abscess, with antibiotic therapy, followed by interval colon resection and anastomosis).1
Consequently, indications and frequency of colostomy have changed over time, but the goal remains to decrease perioperative morbidity in high-risk situations, with the intent to restore intestinal continuity at a later date.
Closure of colostomies has been...