Ostomy Complications and Associated Risk Factors: Development and Testing of Two Instruments

Complications following ostomy surgery can diminish quality of life for individuals, resulting in physical and psychosocial limitations. The purposes of this study were to: 1) identify risk factors contributing to the development of fecal ostomy complications; 2) describe the incidence/severity of early fecal ostomy complications; and 3) estimate the reliability/validity of two new instruments, Ostomy Risk Factor Index (ORFI) and Ostomy Complication Severity Index (OCSI). Using a prospective longitudinal design, 71 adult patients who had ostomy surgery were recruited from three acute care settings. Data were collected through self-administered surveys, medical record review, and direct observation prior to discharge and at 30 to 60 days post-operatively. Data were analyzed using descriptive statistics, ANOVA, chi-square, correlation, and multiple regression. Psychometric properties of the ORFI and the OCSI were examined using content validity indices, Cohen coefficient kappa, Pearson correlation coefficient, and intra-class correlation.

Two risk factors were found to be predictive of ostomy complications scores, stoma/abdomen characteristics (p= .007) and BMI (p= .002). Ostomy complications and ostomy adjustment were significantly inversely correlated (r= - 0.27, p=.04) and stoma care self-efficacy and ostomy adjustment were significantly correlated (r= .599, p= .01). The ORFI and OCSI demonstrated acceptable content validity (CVI= 0.9). ORFI demonstrated acceptable inter-rater reliability for 10 of the 14 items (k= 1.0) and excellent intra-class correlation (r= .998, p= .001). The OCSI demonstrated acceptable inter-rater reliability for all of the items (k= .71- 1.0) and excellent intra-class correlation (r= .991, p= .000). The OCSI demonstrated acceptable internal consistency (Cronbach's alpha .68).

In conclusion, this study provides new knowledge regarding risk factors, incidence and severity of ostomy complications, and provided support for the validity and reliability of two new instruments to reliably identify and describe important contributors (risk factors) and outcomes (complications) that affect care of the patient with an ostomy.