EP913 - Preoperative Stoma Education May Reduce Peristomal Skin Complications Following Colorectal Surgery with New Stoma Formation: A Systematic Review and Meta-Analysis

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Purpose/Background: Patients undergoing new stoma formation following colorectal surgery must be equipped with knowledge and ability to manage their stoma. This education, traditionally occurring postoperatively, often includes information regarding stoma management, lifestyle changes, and psychosocial support. In accordance with more recent surgical guidelines, it has been suggested that stoma education protocols be routinely introduced preoperatively. Potential benefits of such programs include shorter postoperative length of stay (LOS) and decreased readmission following discharge. We designed this systematic review and meta-analysis to further investigate the effect of preoperative stoma education on postoperative outcomes following elective colorectal surgery with new stoma formation.

Methods/Interventions: A search in MEDLINE, Embase, and CENTRAL from inception to February 2024 was performed. We included randomized controlled trials or non-randomized cohort studies evaluating patients who underwent stoma formation during colorectal surgery and compared those receiving and not receiving preoperative stoma education. Main outcomes included stoma-related morbidity, peristomal complications, overall morbidity, postoperative LOS, readmission, and quality of life (QoL). Meta-analyses were performed using inverse variance random effects models. Certainty of evidence was assessed with GRADE.

Results/Outcomes: Nine studies (four randomized studies, five cohort studies) met inclusion criteria. Overall, 507 patients (mean age: 60.9512.86, 40.1% female) received preoperative stoma education prior to stoma formation and 356 patients (mean age: 61.7512.31, 39.2% female) did not. Most stomas were ileostomies (stoma education: 54.6%, no education: 57.6%). Meta-analysis showed that peristomal skin complications were significantly reduced with preoperative stoma education (two studies, 9.5% vs. 19.4%, RR 0.45, 95%CI 0.29-0.72, p< 0.01, I2=0%).There were no significant differences in mean LOS (six studies, MD 0.46, 95%CI -2.73-3.66, p=0.78, I2=95%), overall morbidity (two studies, RR 1.08, 95%CI 0.59-2.0, p=0.79, I2=80%), or readmission (four studies, RR 1.02, 95%CI -0.53-1.98, p=0.94, I2=42%). While QoL data were too heterogenous to meta-analyze, narrative review found that most studies note significant QoL benefits for patients who underwent preoperative stoma education. There were insufficient available data for meta-analysis of stoma-related morbidity. In terms of risk of bias, two studies were found to be at low risk of bias, one was found to be at high risk due to bias in outcome measurement, and the remaining studies were found to be at moderate risk of bias. Overall certainty of evidence for all meta-analyzed outcomes was very low, except peristomal skin complications which had low certainty of evidence.

Conclusion/Discussion: The preoperative use of stoma education may decrease the risk of postoperative peristomal skin complications and improve patient QoL. However, the data informing the use of this intervention represented low-to-very-low certainty evidence and there were no other clinical benefits identified at this time. Future prospective studies are warranted to further strengthen the evidence base for preoperative stoma education prior to colorectal surgery.