RESUMO
PURPOSE: The purpose of this study was to estimate the risk and economic burden of peristomal skin complications (PSCs) in a large integrated healthcare system in the Midwestern United States. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: The sample comprised 128 patients; 40% (n = 51) underwent colostomy, 50% (n = 64) underwent ileostomy, and 10% (n = 13) underwent urostomy. Their average age was 60.6 ± 15.6 years at the time of ostomy surgery. METHODS: Using administrative data, we retrospectively identified all patients who underwent colostomy, ileostomy, or urostomy between January 1, 2008, and November 30, 2012. Trained medical abstractors then reviewed the clinical records of these persons to identify those with evidence of PSC within 90 days of ostomy surgery. We then examined levels of healthcare utilization and costs over a 120-day period, beginning with date of surgery, for patients with and without PSC, respectively. Our analyses were principally descriptive in nature. RESULTS: The study cohort comprised 128 patients who underwent ostomy surgery (colostomy, n = 51 [40%]; ileostomy, n = 64 [50%]; urostomy, n = 13 [10%]). Approximately one-third (36.7%) had evidence of a PSC in the 90-day period following surgery (urinary diversion, 7.7%; colostomy, 35.3%; ileostomy, 43.8%). The average time from surgery to PSC was 23.7 ± 20.5 days (mean ± SD). Patients with PSC had index admissions that averaged 21.5 days versus 13.9 days for those without these complications. Corresponding rates of hospital readmission within the 120-day period following surgery were 47% versus 33%, respectively. Total healthcare costs over 120 days were almost $80,000 higher for patients with PSCs. CONCLUSIONS: Approximately one-third of ostomy patients over a 5-year study period had evidence of PSCs within 90 days of surgery. Costs of care were substantially higher for patients with these complications.
Assuntos
Estomia/efeitos adversos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Dermatopatias/etiologia , Estomas Cirúrgicos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Humanos , Ileostomia/efeitos adversos , Ileostomia/enfermagem , Ileostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Estomia/enfermagem , Estomia/estatística & dados numéricos , Estudos Retrospectivos , Higiene da Pele/métodos , Higiene da Pele/normas , Higiene da Pele/estatística & dados numéricos , Dermatopatias/complicações , Estomas Cirúrgicos/estatística & dados numéricos , Derivação Urinária/efeitos adversos , Derivação Urinária/enfermagem , Derivação Urinária/estatística & dados numéricosRESUMO
The surgical treatment of bowel cancer often results in a digestive stoma, either temporary or permanent. Stoma patients must learn to live with this changed body and intestinal function. They must also adapt their lifestyle to these changes. It is in this direction which the stoma therapy nurse supports the patient.
Assuntos
Neoplasias Colorretais/enfermagem , Colostomia/enfermagem , Ileostomia/enfermagem , Educação de Pacientes como Assunto/normas , Adaptação Psicológica , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/cirurgia , Colostomia/psicologia , Procedimentos Clínicos/normas , França , Humanos , Ileostomia/psicologia , Relações Enfermeiro-Paciente , Qualidade de Vida/psicologia , Especialidades de EnfermagemAssuntos
Processo de Enfermagem/organização & administração , Cuidados Pós-Operatórios/enfermagem , Estomas Cirúrgicos , Assistência Ambulatorial/economia , Assistência Ambulatorial/psicologia , Análise Custo-Benefício , Documentação/economia , Documentação/métodos , Feminino , Serviços de Assistência Domiciliar/economia , Humanos , Ileostomia/enfermagem , Ileostomia/psicologia , Programas Nacionais de Saúde/economia , Avaliação em Enfermagem/economia , Avaliação em Enfermagem/métodos , Processo de Enfermagem/economia , Equipe de Enfermagem/economia , Equipe de Enfermagem/organização & administração , Educação de Pacientes como Assunto/economia , Educação de Pacientes como Assunto/métodos , Cuidados Pós-Operatórios/economia , Neoplasias Retais/economia , Neoplasias Retais/enfermagem , Neoplasias Retais/cirurgia , Autocuidado/economia , Autocuidado/psicologia , Estomas Cirúrgicos/economia , SuíçaAssuntos
Colostomia , Ileostomia , Avaliação em Enfermagem/métodos , Higiene da Pele , Dermatopatias/prevenção & controle , Causalidade , Colostomia/efeitos adversos , Colostomia/enfermagem , Saúde Holística , Humanos , Ileostomia/efeitos adversos , Ileostomia/enfermagem , Modelos de Enfermagem , Enfermeiros Clínicos , Ohio/epidemiologia , Planejamento de Assistência ao Paciente , Sistema de Registros , Medição de Risco , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Dermatopatias/epidemiologia , Dermatopatias/etiologiaRESUMO
BACKGROUND: Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence. Gastrointestinal symptoms are associated with depression, anxiety, and significant impairments in quality of life (QOL) in a significant portion of persons with SCI. OBJECTIVES: 1. To compare clinical, functional, or quality of life outcomes in spinal cord injured patients with gastrointestinal symptoms managed by conservative measures versus intestinal diversion (colostomy or ileostomy). 2. To identify complications associated with ostomy surgery in patients with bowel dysfunction and SCI. SEARCH STRATEGY: A systematic review of electronic databases MEDLINE and CINAHL (from January 1960 to November 2007) was undertaken using the following key words: (1) ostomy, (2) stoma, (3) colostomy, and (4) ileostomy. Boolean features of these databases were used to combine these terms with the key word "spinal cord injuries." Prospective and retrospective studies that directly compared clinical, functional, QOL outcomes or satisfaction among patients with intestinal diversions to patients managed by conservative means were included. RESULTS: Creation of an ostomy in selected patients provides equivocal or superior QOL outcomes when compared to conservative bowel management strategies. Both colostomy and ileostomy surgery significantly reduce the amount of time required for bowel management. Patients who undergo ostomy surgery tend to be satisfied with their surgery, and a significant portion report a desire to be counseled about this option earlier. There are no clear advantages when functional, clinical, or QOL outcomes associated with colostomy are compared to those seen in SCI patients undergoing ileostomy. IMPLICATIONS FOR PRACTICE: 1. The WOC nurse plays a pivotal role in both conservative bowel management and the decision to undergo ostomy surgery. 2. Preoperative stoma site marking is vital for the best surgical outcome. 3. The system best suited to an individual is based on a variety of factors including but not limited to stoma location, type of effluent, peristomal plane and contours, and the individual's capabilities and preferences. 4. Some individuals with a sigmoid or descending colostomy may benefit from colostomy irrigation as a management method. 5. Postoperatively, assessment of pressure points for signs of tissue breakdown, evaluation of treatment methods for existing pressure ulcers with suitable modification, and support surface assessment should be included in ongoing annual follow-up visits.
Assuntos
Colostomia , Incontinência Fecal/terapia , Ileostomia , Traumatismos da Medula Espinal/complicações , Atividades Cotidianas/psicologia , Colostomia/efeitos adversos , Colostomia/enfermagem , Colostomia/psicologia , Enema/métodos , Incontinência Fecal/etiologia , Incontinência Fecal/psicologia , Humanos , Ileostomia/efeitos adversos , Ileostomia/enfermagem , Ileostomia/psicologia , Papel do Profissional de Enfermagem , Satisfação do Paciente , Seleção de Pacientes , Assistência Perioperatória/métodos , Assistência Perioperatória/enfermagem , Qualidade de Vida/psicologia , Projetos de Pesquisa , Resultado do TratamentoRESUMO
This case study describes the management of a patient with complex problems by a urology nurse specialist. Penile amputation and the creation of a colostomy had a severe impact on body image so the patient's care required a holistic approach. He also needed the support of community nurses, and collaboration between them and the urology nurse specialist prevented fragmentation of his care in the end stages of his life.