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Martín-Gil B, Rivas-González N, Santos-Boya T, López M, Jiménez JM, Redondo-Pérez N, Del Río-García I, Berdón-Berdón M, Fernández-Castro M. Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme. Int Wound J 2023; 21:e14456. [PMID: 37963817 PMCID: PMC10898385 DOI: 10.1111/iwj.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.
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Affiliation(s)
- Belén Martín-Gil
- Department of Nursing Care Information Systems, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Noel Rivas-González
- Continual Trainig Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María López
- Nursing Faculty, University of Valladolid, Valladolid, Spain
| | | | - Natán Redondo-Pérez
- Nursing Direction, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Berdón-Berdón
- Nursing Direction, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Watanabe J, Sasabuchi Y, Ohbe H, Nakajima M, Matsui H, Miki A, Horie H, Kotani K, Yasunaga H, Sata N. Impact of Preoperative Stoma Site Marking on Morbidity and Mortality in Patients with Colorectal Perforation: A Nationwide Retrospective Cohort Study. World J Surg 2023; 47:2857-2864. [PMID: 37301796 DOI: 10.1007/s00268-023-07090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Preoperative stoma site marking reduces the incidence of complications from elective surgery. However, the impact of stoma site marking in emergency patients with colorectal perforation remains unclear. This study aimed to assess the impact of stoma site marking on morbidity and mortality in patients with colorectal perforation who underwent emergency surgery. METHODS This retrospective cohort study used the Japanese Diagnosis Procedure Combination inpatient database from April 1, 2012, to March 31, 2020. We identified patients who underwent emergency surgery for colorectal perforation. We compared outcomes between those with and without stoma site marking using propensity score matching to adjust for confounding factors. The primary outcome was the overall complication rate, and the secondary outcomes were stoma-related, surgical, and medical complications and 30-day mortality. RESULTS We identified 21,153 patients (682 with stoma site marking and 20,471 without stoma site marking) and grouped them into 682 pairs using propensity score matching. The overall complication rates were 23.5% and 21.4% in the groups with and without stoma site marking, respectively (p = 0.40). Stoma site marking was not associated with a decrease in stoma-related, surgical, or medical complications. The 30-day mortality did not differ significantly between the groups with and without stoma site marking (7.9% vs. 8.4%, p = 0.843). CONCLUSIONS Preoperative stoma site marking was not associated with a reduction in morbidity and mortality in patients with colorectal perforation who underwent emergency surgery.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan.
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
- Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Tokyo, Japan
| | - Mikio Nakajima
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Tokyo, Japan
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Tokyo, Japan
| | - Atsushi Miki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan
| | - Hisanaga Horie
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Tokyo, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan
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Systematic review with meta-analysis: Current and emerging models of preoperative psychological preparation for individuals undergoing stoma surgery. J Psychosom Res 2023; 168:111211. [PMID: 36898315 DOI: 10.1016/j.jpsychores.2023.111211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Stoma surgery is a profoundly life changing event that can result in a range of negative psychological and mental health outcomes, often requiring significant postoperative adaption. While postoperative avenues of support to address these outcomes exist, there remains a lack of preoperative psychological preparation for surgical candidates in standard models of care. The present systematic review and meta-analysis aims to examine the current and emerging models of psychological preparation available to stoma surgery candidates during the preoperative period. METHODS A systematic search of PubMed, Embase, Emcare, PsycINFO, CINAHL, and SCOPUS was conducted. All studies examining the effects of preoperative psychological interventions targeting postoperative psychological adjustment and/or mental health outcomes for individuals planning to undergo or who had undergone stoma surgery were included. RESULTS Overall, 15 publications meeting inclusion criteria were identified, encompassing 1565 total participants. Intervention types ranged from psychoeducational, counselling, and practical based skills, examining the postoperative outcomes of anxiety, depression, quality of life, adjustment, self-efficacy, and systematic improvements to standard models of care. Five studies examining postoperative anxiety were included for meta-analysis, demonstrating an overall significant effect (SMD = -1.13, 95% CI -1.96 to -0.30, p = .008). Due to the high level of heterogeneity between remaining studies, articles examining postoperative outcomes other than anxiety were synthesised in narrative form. CONCLUSION Despite some promising advancements in the field, there remains insufficient evidence to judge the overall effectiveness of current and emerging models of preoperative psychological preparation on postoperative psychological outcomes for individuals facing stoma surgery.
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Li J, Zhang Q, Wu X, Pang D. The Quality and Clinical Applicability of Recommendations in Ostomy Guidelines: A Systematic Review. Risk Manag Healthc Policy 2022; 15:1517-1529. [PMID: 35971434 PMCID: PMC9375557 DOI: 10.2147/rmhp.s378684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Aim To systematically search ostomy clinical practice guidelines, critically assess their quality and clinical applicability of recommendations, and summarize the recommendations. Design Systematic review. Data Sources The PubMed, ProQuest and CINAHL databases, eight guideline databases, and three ostomy institution websites were searched on September 3, 2021. Review Methods Appraisal of Guidelines for Research and Evaluation II (AGREE II) and AGREE Recommendation EXcellence (AGREE-REX) were used to assess the guideline. Results The initial search identified 1475 documents. Of these, 27 full-text documents were reviewed. Finally, 10 guidelines were included. Among these, the 2019 Registered Nurses’ Association of Ontario (RNAO) guidelines had the highest total scores using AGREE II and AGREE-REX. The 2019 National Institute for Health and Care Excellence (NICE) and 2018 European Hernia Society (EHS) were also ranked as high-quality and evaluated as “recommended.” The median of the “applicability” domain was the lowest (45%) among the six AGREE II domains. The median of the “values and preferences” domain was the lowest (38%) among the three AGREE-REX domains. In total, 172 recommendations were summarized and parastomal hernia received the most attention among the recommendations. Conclusion The quality of the 10 clinical practice guidelines varied widely. The three identified high-quality guidelines might be appropriate first choices in daily ostomy care and management practice and can be tailored to the local context. Ostomy guidelines require further improvement in the “applicability” and “values and preferences” domains. No Patient or Public Contribution This review only searched and evaluated relevant documents, so such details do not apply to this review.
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Affiliation(s)
- Jiamin Li
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Qiuwen Zhang
- School of Nursing, Health Science Center for Evidence-Based Nursing, Peking University, Beijing, People's Republic of China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Dong Pang
- School of Nursing, Health Science Center for Evidence-Based Nursing, Peking University, Beijing, People's Republic of China
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Ambe PC, Kugler CM, Breuing J, Grohmann E, Friedel J, Hess S, Pieper D. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy - A systematic review and meta-analysis. Colorectal Dis 2022; 24:904-917. [PMID: 35297146 DOI: 10.1111/codi.16118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022]
Abstract
AIM This systematic review and meta-analysis aimed to investigate the effect of preoperative stoma site marking on stoma-related complications in patients with intestinal ostomy. METHODS MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient-relevant outcome. Outcomes were prioritised by stakeholder involvement. Random-effects meta-analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS-I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. RESULTS This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma-related complications (OR: 0.45, 95% CI: [0.31-0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health-related quality of life (SMD: 1.13 [0.38-1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06-0.37]) and may decrease dermatological complications (OR: 0.38 [0.29-0.50]) and surgical revision (OR: 0.09 [0.02-0.49]). The confidence in the cumulative evidence was moderate to very low. CONCLUSION Despite low quality evidence, preoperative stoma site marking can prevent stoma-related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.
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Affiliation(s)
- Peter C Ambe
- GFO Kliniken Rhein-Berg, Vinzenz Pallotti Hospital, Bergisch Gladbach, Germany.,Department of Health, Witten/Herdecke University, Witten, Germany
| | | | - Jessica Breuing
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Julia Friedel
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.,University of Cologne, Cologne, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
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Effects of continuous care on health outcomes in patients with stoma: A systematic review and meta-analysis. Asia Pac J Oncol Nurs 2021; 9:21-31. [PMID: 35528792 PMCID: PMC9072188 DOI: 10.1016/j.apjon.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/09/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Continuing care, which is an extension of post-discharge care, is recognized as a crucial element of high-quality health services and is essential to patients. This systematic review aims to identify the effectiveness of continuing care for patients with stomas. Methods PubMed, EMBASE, Cochrane Trial Register and Web of Science databases were searched. Study selection and quality appraisal were performed independently by two reviewers. We calculated the mean differences (MD) or the relative risk (RR) with 95% confidence intervals and assessed heterogeneity. Results Nine studies (1134 participants) met the inclusion criteria. This meta-analysis revealed that, in the continuous care group, the stoma self-efficacy (MD = 6.46; 95% CI = 3.81–9.11; P < 0.001; I2 = 0%), and the quality of life (MD = 7.48; 95% CI = 5.13–9.82; P < 0.001; I2 = 0%) increased significantly 1 month after discharge; stoma adjustment and care satisfaction also showed a trend toward improvement while stoma complications (RR = 0.71; 95% CI = 0.58–0.87; P = 0.001; I2 = 25%) decreased significantly. Continuing care did not decrease hospital readmission rates or medical costs. Conclusions Continuing care showed beneficial effects in improving health outcomes and care satisfaction for patients with stomas compared with routine care. We proposed an integrated continuing care program with different elements and recommendations for its implementation.
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