Maternal outcomes among ostomy patients undergoing vaginal and cesarean deliveries: A national analysis

Background: With the increasing prevalence of conditions requiring stoma creation in younger populations, a growing number of women with ostomies are considering pregnancy. However, limited data exist regarding maternal outcomes at the national level. Methods: codes and stratified based on documentation of an ostomy diagnosis code during the index hospitalization. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included individual complication categories, in-hospital mortality, and resource utilization. Risk-adjusted analyses were performed using entropy balancing and multivariable regression models. Results: Among 13,292,764 delivery hospitalizations, 926 (∼0.01%) involved pregnant women with ostomies. The prevalence of ostomy during deliveries increased 1.5-fold during the 7-year study period from 2016 to 2022, from 7.1 to 10.6 per 100,000 deliveries overall, with specific increases observed for both cesarean (15.3 to 19.9 per 100,000) and vaginal (3.0 to 7.5 per 100,000) deliveries. After risk adjustment, ostomy was associated with increased odds of SMM (adjusted odds ratio [AOR], 1.57; 95% CI, 1.04-2.36). Treatment at medium (AOR, 0.95; 95% CI, 0.94-0.97) and high-volume emergency general surgery (EGS) centers (AOR, 0.94; 95% CI, 0.92-0.96) was associated with reduced odds of SMM. Ostomy was linked with increased hospitalization costs by $1.18k (95% CI, 473-1890), and tendency toward higher odds of 30-day readmission (AOR, 1.54; 95% CI, 0.91-2.60). Conclusion: Maternal ostomy is associated with increased SMM and resource utilization during birthing hospitalizations. However, specialized care at medium and high-volume EGS centers may reduce these risks. These findings highlight the need for specialized protocols for pregnant women with ostomies to optimize maternal outcomes.