Effect of closed and permanent stoma on disease course, psychological well-being and working capacity in Swiss IBD cohort study patients

• Published in: PloS one Vol. 17; no. 9; p. e0274665
• Main Authors: Bianchi, Rahel, Mamadou-Pathé, Barry, von Känel, Roland, Roth, René, Schreiner, Philipp, Rossel, Jean-Benoit, Burk, Sabine, Dora, Babara, Kloth, Patrizia, Rickenbacher, Andreas, Turina, Matthias, Greuter, Thomas, Misselwitz, Benjamin, Scharl, Michael, Rogler, Gerhard, Biedermann, Luc
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16-09-2022; Public Library of Science (PLoS)
• Subjects: Anxiety; Biology and Life Sciences; Cohort analysis; Cohort Studies; Colitis, Ulcerative - complications; Colitis, Ulcerative - surgery; Crohn's disease; Crohns disease; Data collection; Diagnosis; Disease Progression; Family medical history; Health aspects; Humans; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - complications; Intestine; Medicine and Health Sciences; Nonsteroidal anti-inflammatory drugs; Ostomy; Patients; Peritonitis; Psychological aspects; Psychological factors; Psychological stress; Quality of Life; Questionnaires; Reinforcement; Research and Analysis Methods; Social aspects; Social Sciences; Surgery; Switzerland; Ulcerative colitis; Well being; Work capacity; Switzerland; Sweden
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0274665

Little is known about the impact of ostomy formation in inflammatory bowel disease patients on course of disease, psychological well-being, quality of life and working capacity.
We analyzed patients over a follow-up of up to 16 years in the Swiss inflammatory bowel disease cohort study (SIBDCS) with prospective data collection. We compared Ulcerative colitis and Crohn's disease patients with and without ostomy as well as permanent and closed stoma formation before and after surgery, investigating disease activity, psychological wellbeing and working capacity in a case-control design.
Of 3825 SIBDCS patients, 176 with ostomy were included in the study and matched with 176 patients without ostomy using propensity score, equaling 352 patients for the analysis. As expected, we observed a lower mean and maximal disease activity in patients after stoma surgery compared with control patients without stoma. Overall, psychological wellbeing in patients with stomas vs. controls as well as patients with permanent vs. closed stoma was similar in terms of disease-specific quality of life (total score of the Inflammatory Bowel Disease Quality of Life questionnaire), psychological distress (total score of the Hospital Anxiety and Depression Scale), and stress at work (effort-reward-imbalance ratio), with the exception of a higher Posttraumatic Diagnostic Scale total score in patient with vs. without stoma. Compared to IBD patients without stoma, the adverse impact on working capacity in overall stoma IBD patients appeared to be modest. However we observe a significantly higher reduction in working capacity in permanent vs. closed stoma in CD but not UC patients.
As to be expected, IBD patients may benefit from closed and permanent stoma application. Stoma surgery appears to only modestly impact working capacity. Importantly, stoma surgery was not associated with adverse psychological outcomes, with comparable psychological well-being regardless of presence and type of stoma.