Impact of stoma revision surgery on quality of life: the STICK-II retrospective cohort study

INTRODUCTION: Stoma placement is a frequently performed procedure. Short- and long-term stoma-related complications affect up to 80% of patients and are known to reduce quality of life (QoL). Stoma revision surgery may be indicated, but its influences on QoL have not been studied. METHODS: The precursor to this study, the SToma applIanCe leaKage and its risk factors, consequences and preventive treatments (STICK-I) was a retrospective cohort study conducted across three hospitals between 2019 and 2022. Patients with a colostomy, ileostomy, or certain type of urostomy for at least 1 year were included. The data of the STICK-I study were used for this substudy. The stoma-QoL score was compared between a stoma revision surgery and a control group using propensity matching. Patients stoma-QoL scores before and after revision surgery were separately analyzed as their own controls. RESULTS: Out of 643 patients, 336 completed the questionnaire, of whom 65 were assigned to the revision group, 216 to the control group, and 10 to the own-control group. Matching resulted in comparable baseline parameters, except for sex. Other baseline characteristics were equally distributed among the groups. The stoma-QoL scores in patients who had undergone stoma revision (mean 56, 95% CI 52-60) did not significantly differ from those who did not undergo stoma revision (mean 59, 95% CI 57-61), (mean difference 2.61, p = 0.160). Patients in the own-control group scored significantly higher on the stoma-QoL after revision surgery (mean 62, 95% CI 52-71) compared with before (mean 55, 95% CI 45-65), (mean difference 6.90, p = 0.048). CONCLUSIONS: Postoperative stoma-QoL scores were similar to controls who did not undergo revision. Furthermore, stoma-QoL scores significantly improved after stoma revision surgery. Postoperative stoma-QoL scores in the matched cohort did not differ significantly from controls; a small within-patient sample showed a clinically relevant increase after revision. These exploratory findings suggest that QoL improves after revision, but prospective studies with standardized pre- and postoperative assessment are required to confirm this.