Factors predictive of optimal peristomal skin status in patients with an ostomy: a secondary analysis

Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) ( Bueno Cruz et al, 2021 ) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care.

The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy—protocol of a systematic review and meta-analysis

Background An intestinal ostomy is an artificial bowel opening created on the skin. Procedure-related mortality is extremely rare. However, the presence of an ostomy may be associated with significant morbidity. Complications negatively affect the quality of life of ostomates. Preoperative stoma site marking can reduce stoma-related complications and is recommended by several guidelines. However, there is no consensus on the procedure and recommendations are based on low-quality evidence. The objective of the systematic review will be to investigate if preoperative stoma site marking compared to no preoperative marking in patients undergoing intestinal stoma surgery reduces or prevents the rate of stoma-related complications. Methods We will include (cluster-) randomised controlled trials and cohort studies that involve patients with intestinal ostomies comparing preoperative stoma site marking to no preoperative marking and report at least one patient-relevant outcome. For study identification, we will systematically search MEDLINE/PubMed, EMBASE, CENTRAL and CINHAL as well as Google Scholar, trial registries, conference proceedings and reference lists. Additionally, we will contact experts in the field. Two reviewers will independently perform study selection and data extraction. Outcomes will be prioritised based on findings from telephone interviews with five ostomates and five ostomy and wound nurses prior to conducting the review. Outcomes may include but are not limited to stoma-related complications (infection, parastomal abscess, hernia, mucocutaneous separation, dermatological complications, stoma necrosis, stenosis, retraction and prolapse) or other patient-relevant postoperative endpoints (quality of life, revision rate, dependence on professional care, mortality, length of stay and readmission). We will use the ROBINS-I or the Cochrane risk of bias tool to assess the risk of bias of the included studies. We will perform a meta-analysis and assess the certainty of evidence using the GRADE approach. Discussion With the results of the systematic review, we aim to provide information for future clinical guidelines and influence clinical routine with regard to preoperative stoma site marking in patients undergoing ostomy surgery. When the evidence of our systematic review is low, it would still be a useful basis for future clinical trials by identifying data gaps. Systematic review registration PROSPERO registration number: CRD42021226647

The effect of pre-operative stoma-site marking on peristomal skin health and quality of life

Aim: To determine the effect of pre-operative stoma-site marking (siting) on ostomates' peristomal skin health and quality of life (QoL). Methods: The Uses and Attitudes in Ostomy (U&A Ostomy) study was conducted across 148 stoma units in Spain. Specialist stoma care nurses personally assessed each ostomate and collected demographic and clinical data. This included whether the stoma was sited before surgery, the stoma's characteristics, the type of appliance used, any stoma-related complications and frequency of leakage. Participants were also assessed using the Discolouration, Erosion, Tissue overgrowth (DET) Ostomy Skin Tool (0–15), Global Wellbeing scale (0–10) and Stoma-QoL scale (0–100). Findings: The study included 871 ostomates. Of these, 64% were male and 36% were female, the mean age was 64±13 years and the mean BMI was 26.5±11; 57.5% had a colostomy, 28.6% had an ileostomy and 13.9% had a urostomy. A stoma site had been pre-operatively marked and respected in 53.1%, marked but not respected in 2.1% and not marked in 44.8% of the cases. The proportion of new ostomates whose stoma had been sited was seen to have increased in recent years. Stoma siting was associated with a permanent ostomy (p=.0001), absence of effluent leakage (p=.008), absence of complications (p<.0001), lower DET score (p.0007), higher Stoma-QoL score (p=.018) and higher global wellbeing score (p=.0018). Multivariate analysis revealed that pre-operative stoma siting (p<.0001) and type of ostomy (p<.0001) were independent predictors of optimal peristomal skin (DET score 0). The Stoma-QoL score was higher in ostomates with pre-operative stoma siting (58.3±10.2 vs 57±10.3; p=.018). Global wellbeing was also higher in those with pre-operative stoma siting (7.6±1.8 vs 7.19±1.9; p=.0018). Conclusions: In Spain, pre-operative stoma siting is not yet consistently applied in practice, despite the educative efforts made by health professionals. Stoma siting is a first-line opportunity to reduce the occurrence of peristomal skin complications (PSCs), and thus it is associated with fewer PSCs and greater self-perceived QoL. More effort is needed to extend this practice to the majority of patients undergoing stoma-forming surgery.

RELATIONSHIP BETWEEN THE KNOWLEDGE ON SELF-EFFICACY ABOUT COUNSELING AND STOMA SITE MARKING FOR PATIENTS UNDERGOING STOMA SURGERY IN ETNs

Stoma complications may affect physical and psychological aspects in patients’ life. The implementation of counseling and stoma site marking prior to surgery can reduce the risk of complications and improve the quality the life of the patients. Enterostomal Therapy Nurse (ETN) is a nurse graduated of an educational program called ETNEP (Enterostomal Therapy Nurse Education Program). Self-efficacy of ETNs plays vital role in application of counselling and stoma site marking. This study aimed to evaluate knowledge and self-efficacy of ETNs and to investigate the relationship between the knowledge and self-efficacy about counseling and stoma site marking in ETNs. A cross sectional design was used which involved 81 ETNs in Indonesia. The study was conducted in 2017. The data were collected by using online questionnaire in a 3-part on ETNs's demographic characteristics, knowledge of counseling and stoma site marking (27 questions) and self-efficacy (33 questions). The data collecting process designed by google form then analyzed by using Chi Square test. Findings showed that there was a statistically significant correlation between the knowledge and self- efficacy (p=0,008, OR=3,808). An increase in knowledge corresponded with an improvement in the self- efficacy about counseling and stoma site marking in ETNs. This recommended every hospitals with stoma care may improve ETNs knowledge about counseling and stoma site marking periodically.

Altered body image in stoma patients: evaluation through classification of nursing outcomes

Aims: The aim of this study was to determine how satisfied ostomates were with their body image and how well they had adapted to stoma surgery. Method: A cross-sectional descriptive study recorded demographic and clinical variables using two body-image indicators from the nursing outcomes classification (NOC) taxonomy ‘Body image’ (NOC 1200): ‘Satisfaction with body appearance’ (NOC 120005) and ‘Adjustment to body changes due to surgery’ (NOC 120014) on a Likert scale. Results: Average satisfaction was 2.80 (SD 0.452) and average adjustment was 3.04 (SD 0.450). Relationships with the variables were not statistically significant but could be observed on a descriptive level. Higher satisfaction and/or adjustment scores were linked to female sex, age over 68 years and not belonging to an ostomy association, as well as an oncological diagnosis, stoma site marking, the postoperative period before follow-up and stoma formation in the past year. Conclusions: Despite a limited sample size of 102 patients, this study has practical implications. It provides a better understanding of the factors that influence body image in ostomates with a colostomy or ileostomy, which should guide stoma care nurses in caring for the needs of patients.

Risk factors associated with peristomal skin complications: Integrative literature review

Surgical intervention of colorectal cancer often includes formation of ostomy. Irrespective of the type of stoma, many ostomy patients suffer from peristomal skin complications. Identifying risk factors related to peristomal skin complications is one of the crucial factors in maintaining peristomal skin health. The purpose of this integrative review is to identify the risk factors associated with the development of peristomal skin complications. Whittmore and Knafl’s (2005) framework for integrative literature review guided this study. The results of this systematic literature review showed risk factors for developing peristomal skin complications are multidimensional. Leakage of stoma output, type and structure of stoma, stoma site marking and nature of surgery, ostomy education, ostomy appliances, mechanical trauma, and demographic factors are the most commonly identified risk factors in the development of peristomal skin complications. The development of peristomal skin complications is closely associated with skin contact with ostomy effluent. In all settings ostomy patients requires specialized care and management to prevent development of peristomal skin complications and promote quality of life. The findings of this focused study suggest that prevention and early identification of risk factors related to peristomal skin complications are very important.