Factors associated with clinical path deviation in patients undergoing stoma surgery

Abstract

Purpose: The present study aimed to identify factors associated with clinical path (CP) deviation in patients who underwent stoma surgery using its CP.

Methods: The subjects were patients who underwent lower gastrointestinal surgery with stoma formation, for which its CP was applied, between January 2019 and March 2022. They were retrospectively reviewed, and their independent risk factors for CP deviation were identified by multivariate analysis comparing the CP deviant and non-deviant groups. CP deviation was defined as hospitalization for more than 10 postoperative days. A similar analysis was performed for prolonged hospitalization defined as hospitalization for 17 or more postoperative days.

Results: A total of 78 patients (median age 68 years, 51 males) were reviewed. CP deviation was seen in 62 (79.5%) patients, and their independent risk factors were postoperative complications, unemployment, and stool leakage from the stoma bag. Prolonged hospitalization was seen in 24 (30.8%) patients, and their independent risk factors included open surgery, postoperative complications, stoma complications, and stool leakage from the stoma bag.

Conclusion: To shorten hospitalization duration, attention should be paid to postoperative complications, as well as to educate patients about stoma selfcare taking into account stoma complications and stool leakage from the stoma bag. Because the CP deviation rate was high in our hospital, revision and improvement to our CP itself, including the allowed number of postoperative days for hospitalization, might be necessary.