Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis

The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor. A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS). Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75–6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed <i>via</i> laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%. The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.

本项系统综述旨在明确、批判性评估并总结可导致造口并发症发生的危险因素，同时报告合并发生率及各危险因素对应的分层发生率。本研究遵循PRISMA（系统综述与Meta分析优先报告条目）声明及研究流程图规范，开展了一项纳入观察性研究的Meta分析类系统文献综述。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale, NOS）对纳入文献开展质量评价。最终纳入1990年至2018年间发表的16篇聚焦肠道造口并发症相关危险因素的文献，经本次分析识别出可干预与不可干预的两类危险因素。纳入文献的NOS评分中位数为6（四分位距=5.75~6）。在纳入的10520例患者中，无论并发症性质如何，造口并发症的合并发生率为35%，范围为9%~63%。亚组分析结果显示，肥胖患者群体以及经腹腔镜手术或急诊手术施行造口术的患者，其造口并发症发生率分别高达66%和68%。造口并发症的合并发生率具有重要的流行病学意义，需予以更多关注。从临床实践视角出发，肥胖及伴有慢性基础疾病的患者需得到更多关注以预防并发症，可通过精准的教育干预提升造口规范管理水平。