Risk & Economic Burden of Peristomal Skin Complications (PSCs) in Patients with Recent Ostomies

Objective.  To estimate the risk and economic burden of peristomal skin complications (PSCs) in patients with recent ostomies in a large US integrated healthcare system.

Methods.  We retrospectively identified 168 patients who underwent colostomy (ICD-9-CM 46.1X), ileostomy (46.2X), cutaneous uretero-ileostomy (56.5X), or other external urinary diversion (56.6X) between January 2012 and December 2014, using administrative data stores. Among these patients, we then identified those subjects who developed PSCs within 90 days of their surgery, based on medical record review.  Using administrative data stores again, we compared levels of healthcare utilization and costs over 120 days, beginning with the date of surgery, between patients with evidence of PSCs and those without evidence of PSCs.  Analyses of study data were descriptive in nature.

Results.  Sixty-one patients (36.3%) had evidence of PSCs in the 90-day period following surgery, including 47.5% of ileostomy patients, 36.1% of colostomy patients, and 15.0% of urinary diversion patients. Mean (SD) time from surgery to first notation of a PSC was 26.4 (19.0) days, ranging from 24.1 (13.2) days for ileostomy, to 27.2 (21.1) days for colostomy, and 31.7 (25.7) days for urinary diversion.  Patients with PSCs were more likely to be readmitted to hospital within the 120‑day observation period (55.7% vs 35.5% among those without PSCs) and have longer stays in hospital (mean, 11.0 days vs 6.8 days respectively).  Total healthcare costs over this period were almost $7500 higher among patients with PSCs versus those without evidence of these complications.

Conclusions.  Approximately one-third of patients with ostomies develop PSCs within 90 days of surgery, associated with a higher incidence of rehospitalization and higher costs of care.