Do trauma stomas ever get reversed?

Background: There is a paucity of information about the frequency and timing of reversal after stoma creation for trauma. In addition, the barriers to reversal faced by those patients are largely unknown. We hypothesize that the rate of stoma creation and reversal are low among trauma patients. Additionally, we sought to identify patient-related barriers to stoma reversal.

Study design: Analysis of the California Office of Statewide Health Planning and Development patient database, 1995-2010. Inclusion criteria were all trauma patients with hollow viscus injury. Exclusion criteria were presence of a stoma at the time of injury or death within 48 hours of admission. Patient characteristics studied included age, sex, race, Survival Risk Ratio, Charlson Comorbidity Index, and insurance status. Kaplan-Meier, logistic regression, and Cox proportional hazard analysis were performed to identify predictors of immediate and eventual reversal.

Results: A total of 35,346 patients had hollow viscus injury, 3,899 resulted in stoma creation; 249 (6.4%) were reversed during their initial hospitalization. After discharge, 41% of patients were reversed at 6 months, 61% at 1 year, and 72% at 5 years. Stoma reversals occurred at a different hospital from the initial admission 57.1% of the time. Black race was a significant predictor for stoma reversal during the initial hospitalization. After the initial admission, having insurance increased the likelihood of reversal significantly; however, those of black and Hispanic race had a decreased rate.

Conclusions: The stoma reversal rate appears to be higher than we hypothesized; this is most likely due to the high rate of patient migration between hospitals. The factors that posed substantial barriers to reversal after initial admission were lack of health insurance and black and Hispanic race/ethnicity.