Efficacy of sodium zirconium phosphate alginate dressings for peristomal dermatitis after gastrointestinal surgery: A retrospective study

Abstract

BACKGROUND

Peristomal dermatitis is a common postoperative complication that compromises the comfort and quality of life of the patient, and its effective management remains complex.

AIM

To evaluate the efficacy of sodium zirconium phosphate alginate dressings in managing post-gastrointestinal surgery peristomal dermatitis, and provide evidence for optimal clinical intervention and enhanced patient outcomes.

METHODS

This retrospective analysis included 120 patients with peristomal dermatitis who were admitted between September 2023 and November 2024. The observation group (n = 56) received sodium zirconium phosphate alginate dressings, while the control group (n = 64) was treated with conventional dressing changes. Baseline characteristics were assessed through 1:1 propensity score matching using the nearest-neighbor method, finally enrolling 45 patients per group. Clinical efficacy was assessed after 12 days of intervention. Skin conditions were compared pre- and at 3-, 6-, 9-, and 12-days post-intervention. Complication incidence and patient satisfaction rates were statistically analyzed.

RESULTS

The overall response rate was significantly higher in the observation group than in the control group (93.33% and 42/45 vs 77.78% and 35/45) (P < 0.05). At 9- and 12-days post-intervention, compared with the control group, the observation group exhibited lower discolouration, erosion, tissue overgrowth/assessment, intervention, monitoring (DET/AIM) scores (P < 0.05). The incidence of complications was lower in the observation group (4.44%, 2/45) than in the control group (22.22%, 10/45) (P < 0.05). The observation group exhibited higher satisfaction for intervention (95.56%, 43/45) compared with the control group (75.56%, 34/45) (P < 0.05).

CONCLUSION

The outcomes after using sodium zirconium phosphate alginate dressings for peristomal dermatitis in gastrointestinal surgery are satisfactory. These dressings improve patients’ skin condition, reduce complication risks, and improve patient satisfaction with the intervention.

Key Words: Gastrointestinal surgery; Peristomal dermatitis; Sodium zirconium alginate dressing; Complications; Satisfaction

Core Tip: This retrospective study demonstrates that sodium zirconium alginate dressings are an effective intervention for peristomal dermatitis after gastrointestinal surgery. Compared to conventional dressings, their use resulted in significantly higher clinical efficacy, improved skin condition scores (discolouration, erosion, tissue overgrowth/assessment, intervention, monitoring), lower complication rates, and greater patient satisfaction, offering a superior management strategy for this common postoperative complication.

INTRODUCTION

Colostomy is a common surgical procedure in digestive system interventions, primarily performed for patients with colorectal cancers. It involves exteriorizing the affected intestinal segment and anastomosing the intestinal mucosa to the abdominal wall to form a functional stoma. This restores the intestinal continuity and the function of the digestive tract and improves patient’s quality of life[1,2]. However, colostomy can lead to various complications, and peristomal skin inflammation is particularly common. Impaired skin integrity compromises skin defence and enables pathogens to infect surrounding tissue, causing oedema, erosion, hyperaemia, and even ulceration, with severe pain that adversely affects both physical and psychological wellbeing of the patient[3,4]. Therefore, careful management of peristomal skin is essential. While conventional care relies on passive barrier protection using skin powders or protective films, these lack antimicrobial activities. Frequent changes in the ostomy pouch may increase skin friction, further elevating the risk for dermatitis[5]. Unlike conventional dressings, sodium zirconium phosphate alginate dressings provide sustained release of silver ions (Ag⁺), which effectively suppress pathogens such as Pseudomonas aeruginosa and Staphylococcus aureus and support granulation tissue development and wound repair[6]. Accordingly, this study aimed to evaluate the efficacy of sodium zirconium phosphate-silver alginate dressings in treating post-gastrointestinal surgery peristomal dermatitis, with the goal of optimizing clinical intervention strategies and improving patient outcomes. The research findings are presented below.

MATERIALS AND METHODS

General data acquisition

This retrospective analysis was conducted on 120 patients having peristomal dermatitis admitted between September 2023 and November 2024. In the control group, there were 64 patients who received conventional wound dressing care, whereas the observation group had 56 patients who received sodium zirconium phosphate alginate dressings. The criteria for inclusion were: Individuals who had: (1) A first-time permanent colorectal stoma; (2) Complete clinical records; and (3) Age 18 years or older. The criteria for exclusion were: Individuals who had: (1) Severe complications; (2) Multiple stoma procedures; (3) Postoperative mortality; (4) Autoimmune disorders; (5) Psychiatric disorders; (6) Severe comorbidities such as hepatic/renal failure or acute diabetes; (7) Systemic infection; and (8) Severe organ failure.

Method

Patients in the control group were treated with conventional wound dressing care. The stoma and surrounding peristomal skin were assessed and gently cleaned using cotton balls dipped in warm saline, ensuring the removal of fecal residue from skin folds and depressions. In intestinal fluid overflow cases, fecal leakage was prevented by inserting a mushroom-tip drainage tube into the stoma. The skin area, after cleaning, was dried thoroughly using sterile gauze. A skin protection powder was evenly applied over the site of dermatitis, followed by a skin barrier film in a clockwise direction as a protective layer, and the ostomy pouch was attached. Patients were advised to avoid activities that increase pressure on the abdomen (e.g., bending) and to replace the pouch daily. The baseplate was replaced immediately if permeation ≥ 1 cm area or leakage within 24 hours was noted.

Patients in the observation group were treated with dressings prepared from zirconium silicate silver phosphate alginate (Advanced Medical Solutions Ltd., National Medical Device Registration: No. 20193141871). After disinfecting the wound and surrounding tissue with sterile saline, the area was gently patted dry and thoroughly cleared of fecal matter or necrotic tissue. The wound cavity was then filled with the zirconium silicate silver phosphate alginate dressing, ensuring it was level with the surrounding skin and not compact, as excessive packing could hinder exudate absorption. A protective system was then sequentially applied, starting with stoma care powder, anti-leakage ointment, and a skin barrier film. The stoma pouch was secured and the dressing change frequency was adjusted depending on the volume of wound exudate following the criteria: Heavy exudate (≥ 2/3 of impregnated dressing area): To be changed daily; Moderate exudate (1/3-2/3 of impregnated dressing area): To be changed every 2 days; Light exudate (≤ 1/3 of impregnated dressing area) or no significant exudate: May change every 3 days. Wound healing progress and surrounding skin condition were assessed at each dressing change, and subsequent management plans were dynamically adjusted accordingly. The sodium zirconium phosphate-silver alginate dressing used in this study was composed of high-G calcium alginate fibers, sodium carboxymethylcellulose, zirconium phosphate compounds (as ion-exchange carriers), and Ag⁺ for sustained antimicrobial activity, with polyethylene glycol as a hydrophilic matrix. This formulation enabled ion-exchange release of Ag⁺, rapid absorption of exudates, and the formation of a moist cohesive gel.

Observation indicators

Clinical efficacy: After 12 days of intervention, clinical efficacy was evaluated based on following established criteria[7]: Cured: Ulcer healed, normal skin appearance restored, and skin erosion and hyperemia resolved; Marked improvement: A reduction of > 50% in [dermatological evaluation tool for peristomal area discolouration, erosion, tissue overgrowth/assessment, intervention, monitoring (DET/AIM) score and a reduction in affected skin area > 50%]; Effective: 25%-50% reductions in DET/AIM score and damaged skin area; Ineffective: < 25% reductions in DET/AIM score and damaged skin area. The total effective rate was the sum of cured and markedly effective cases.

Skin condition: This was evaluated at baseline and at 3-, 6-, 9-, and 12-days post-intervention using the DET/AIM score[8]. This scale is employed to evaluate three symptoms (color change, tissue proliferation, and maceration/ulceration) and two wound indicators (damaged area: 0-3 points; Severity: 0-2 points). The total score was computed as the sum of the above-mentioned scores and ranged from 0 to 15 points, with a lower score indicating better skin condition.

Complications: For both groups, the incidence of bowel dysfunction, infection, and stomal stenosis was recorded.

Satisfaction with the intervention: Post-intervention satisfaction was measured using a hospital-designed questionnaire (Cronbach’s α = 0.855) to assess intervention efficacy and pain relief. The rating of scores was performed according to a 100-point scale. A score of > 90 indicated satisfaction, < 75 indicated dissatisfaction, and 75-90 indicated basic satisfaction. The combined proportion of basic satisfaction and satisfaction represented the overall satisfaction.

Statistical analysis

Data were analyzed using SPSS v 27.0 software. Samples were matched using a 1:1 nearest neighbor algorithm employing a caliper width of 0.004 to ensure precision. Then, covariate balance was assessed through standardized mean difference tests, with the absolute values of standardized differences for all variables being < 10%, suggesting excellent intergroup comparability among the matched samples. Categorical data (satisfaction, gender, etc.) were expressed as n (%) and analyzed using χ² tests. Continuous data (age, DET/AIM scores, etc.) were tested for normality using the Shapiro-Wilk test. Normally distributed variables were presented accordingly. For within-group and between-group comparison, paired and independent samples t-tests, respectively, were applied. Statistical significance was set at α = 0.05.

RESULTS

Propensity score matching results

Before initiating propensity score matching, significant differences were observed between the observation (56 cases) and control (64 cases) groups, in gender, age, body mass index, stoma type, and duration of peristomal dermatitis (P < 0.05). After 1:1 propensity score matching, comparisons between the observation and control groups (45 cases each) exhibited differences that were not statistically significant (P > 0.05), demonstrating good comparability (Tables 1 and 2).

Table 1 Results before propensity score matching, mean ± SD/n (%).

Group	Sex		Age (year)	BMI (kg/m2)	Onset of dermatitis (day)	Stoma type
	Male	Female				Ileostomy	Colostomy
Observation (n = 56)	38 (67.86)	18 (32.14)	64.35 ± 3.51	23.87 ± 1.35	6.75 ± 0.88	17 (30.36)	39 (69.64)
Control (n = 64)	32 (50.00)	32 (50.00)	60.22 ± 3.14	23.04 ± 1.25	7.20 ± 0.78	31 (48.44)	33 (51.56)
Statistical value	χ2 = 3.918		t = 6.803	t = 3.496	t = 2.970	χ2 = 4.068
P value	0.048		< 0.001	0.001	0.004	0.044

BMI: Body mass index.

Table 2 Results after propensity score matching, mean ± SD/n (%).

Group	Sex		Age (year)	BMI (kg/m2)	Onset of dermatitis (day)	Stoma type
	Male	Female				Ileostomy	Colostomy
Observation (n = 56)	28 (62.22)	17 (37.78)	63.04 ± 3.49	23.35 ± 1.48	6.88 ± 0.89	15 (33.33)	30 (66.67)
Control (n = 64)	26 (57.78)	19 (42.22)	62.80 ± 3.57	23.29 ± 1.50	7.02 ± 0.82	18 (40.00)	27 (60.00)
Statistical value	χ2 = 0.185		t = 0.323	t = 0.191	t = 0.776	χ2 = 0.431
P value	0.667		0.748	0.849	0.440	0.512

BMI: Body mass index.

Clinical efficacy

The total effective clinical efficacy rate was 93.33% (42/45) in the intervention group, significantly higher than the rate of 77.78% (35/45) reported for the control group (P < 0.05) (Table 3).

Table 3 A comparison of clinical efficacy between two groups, n (%).

Group	Recovered	Markedly effective	Effective	Ineffective	Overall effective rate
Observation (n = 56)	28 (62.22)	14 (31.11)	3 (6.67)	0 (0.00)	42 (93.33)
Control (n = 64)	24 (53.33)	11 (24.44)	8 (17.78)	2 (4.44)	35 (77.78)
χ2 value					4.406
P value					0.036

Skin condition

At 9 and 12 days post-intervention, the intervention group had lower DET/AIM scores compared with the control group (P < 0.05); the differences observed in DET/AIM scores among the two groups at baseline, 3- and 6-days post-intervention were not statistically significant (P > 0.05) (Table 4).

Table 4 A comparison of discolouration, erosion, tissue overgrowth/assessment, intervention, monitoring scores between two groups (points), mean ± SD.

Group	Pre-intervention	Post-3 days	Post-6 days	Post-9 days	Post-12 days
Observation (n = 56)	8.52 ± 1.03	7.48 ± 0.95	6.67 ± 0.88	4.20 ± 0.74	2.28 ± 0.54
Control (n = 64)	8.65 ± 0.97	7.64 ± 0.87	7.04 ± 0.91	5.71 ± 0.85	4.63 ± 0.71
t value	0.616	0.833	1.961	8.988	17.673
P value	0.539	0.407	0.053	< 0.001	< 0.001

Complications

The incidence of complications was 4.44% (2/45) in the observation group, significantly lower than in the control group (22.22%, 10/45) (P < 0.05) (Table 5).

Table 5 A comparison of complications between the two groups, n (%).

Group	Abnormal bowel	Stoma infection	Stoma stenosis	Overall incidence
Observation (n = 56)	2 (4.44)	0 (0.00)	0 (0.00)	2 (4.44)
Control (n = 64)	5 (11.11)	2 (4.44)	3 (6.67)	10 (22.22)
χ2 value				6.154
P value				0.013

Satisfaction

Satisfaction with the intervention was higher in the observation group (95.56%, 43/45) than in the control group (75.56%, 34/45) (P < 0.05) (Table 6).

Table 6 A comparison of satisfaction levels between the two intervention groups, n (%).

Group	Satisfied	Generally satisfied	Not satisfied	Overall satisfaction
Observation (n = 56)	27 (60.00)	16 (35.56)	2 (4.44)	43 (95.56)
Control (n = 64)	19 (42.22)	15 (33.33)	11 (24.44)	34 (75.56)
χ2 value				7.283
P value				0.007

DISCUSSION

Intestinal ostomy surgery is a vital means of sustaining and improving the lives of patients requiring intestinal diversion. In China, the overall complication rate among ostomy patients ranges from 16% and 54%, with peristomal dermatitis occurring in 4% to 26% of cases[9]. The pathogenesis of peristomal dermatitis is multifactorial. Mechanical irritation from frequent ostomy pouch changes manifests as skin trauma, chemical injury caused by prolonged exposure to alkaline digestive fluids and feces, and immunological hypersensitivity to stoma materials in allergic individuals, manifest as inflammatory responses. These processes manifest as local inflammatory responses like skin erosion, hyperemia, and edema, and in severe cases, may progress to ulcerations accompanied by considerable pain, adversely impacting the quality of life[10-12].

Given these circumstances, targeting peristomal skin care is clinically significant. Conventional management primarily involves the following dressing protocols: Cleansing the affected area with saline and applying stoma powders and skin protectants to provide a physical barrier. Although this approach offers basic relief, its limitations are evident. Traditional stoma powders primarily absorb exudate but lack broad-spectrum antimicrobial properties, while conventional dressing materials find it difficult to dynamically maintain moisture balance in the wound microenvironment, resulting in either excessive dryness or moisture retention both of which disrupt the normal wound healing[13,14]. Dressings comprising sodium zirconium phosphate alginate primarily contain sodium carboxymethylcellulose, high-G calcium alginate, compounds with Ag⁺, and polyethylene glycol. These dressings release Ag⁺ upon contact with wound exudate, exhibiting significant antibacterial activity and creating a favorable wound healing environment[15].

In this study, the intervention group had a higher effective rate and lower DET/AIM scores compared with the control group, indicating superior clinical efficacy of sodium zirconium phosphate-silver alginate dressings in managing peristomal dermatitis in gastrointestinal surgery. The improved performance is attributed to the swelling effect triggered by calcium alginate and sodium carboxymethylcellulose within this dressing upon adsorbing wound exudate, thereby forming a cohesive, soft gel. This gel efficiently absorbs exudate and prevents leakage and skin maceration. Concurrently, it promotes cellular repair and granulation tissue growth by maintaining a moist wound environment, thereby accelerating wound healing in patients with peristomal dermatitis and improving their skin conditions[16,17]. The reticular gel structure forms when the dressing is in contact with the wound surface, facilitating blood coagulation, and its gauze-like texture prevents sticking to the wound surface, thereby minimizing nerve stimulation. These attributes help to alleviate pain effectively, promote wound healing, and improve the patient's skin condition[18,19].

In terms of complications and patient satisfaction, the observation group showed a lower rate of complication and higher satisfaction compared to the control group. These results indicate that the proposed dressings are effective in reducing complications and improving patient experience, largely due to their Ag⁺-mediated antimicrobial activity. Ag⁺ affect pathogens by disrupting their cell membranes, interfering with key metabolic enzymes, and preventing DNA replication, leading to significantly reduced infection rates. Meanwhile, the alginate component rapidly absorbs exudate and forms a semi-permeable gel barrier, thereby maintaining an optimal moisure and isolating irritants, enabling the formation of granulation tissue and lowering the incidence of complications[20,21]. The polymeric matrix contributes to exudate management by forming an adsorbent gel that captures and immobilizes both microorganisms and necrotic debris, while its anti-adhesive properties prevent trauma to newly formed tissue during dressing changes[22,23]. Additionally, sodium zirconium phosphate alginate dressings alleviate postoperative packing discomfort, reducing defecation urge and heaviness, thereby contributing to greater patient comfort and satisfaction[24,25].

Apart from clinical efficacy, cost-effectiveness represents an important consideration for the clinical adoption of advanced dressings. Although this study confirmed the clinical benefits of silver zirconium phosphate alginate dressings, their cost-effectiveness was not evaluated. However, their higher unit cost may be offset by longer intervals between dressings, faster healing, and fewer complications, potentially reducing the overall medical expenditure. Future research should incorporate economic analyses to assess total treatment costs, resource utilization, and nursing workload, to provide more comprehensive evidence for healthcare decision-making.

In this study, the observation group exhibited a significantly higher satisfaction rate, possibly because of several performance advantages. For example, its excellent exudate management reduces leakage concerns and enhances convenience; the soft gel texture alleviates pain and discomfort during dressing change; and less frequent need for replacement decreases nursing workload and also improves convenience. Identifying these satisfaction parameters can help to refine nursing protocols. In the future, targeted health education focusing on these advantages could further enhance patient cooperation and overall experience.

This study has several limitations. First, although propensity score matching was applied to balance the baseline characteristics and minimize the impact of known confounders, the intrinsic nature of a retrospective study design precludes the complete elimination of unmeasured or unidentified confounding factors. Residual confounding may still exist and could potentially have influenced the observed associations. Therefore, causal inference should be interpreted with caution. Second, the assessment of patient satisfaction relied on a hospital-developed questionnaire. Although the reliability of the questionnaire was supported by a Cronbach’s α coefficient, the tool lacked formal validation of its content, construct, and criterion validity. The absence of such psychometric testing may have compromised the accuracy and interpretability of the subjective satisfaction outcomes. These limitations underscore the need for future prospective, multicenter studies employing validated measurement tools to strengthen the robustness and generalizability of the findings.

CONCLUSION

In summary, sodium zirconium phosphate alginate dressings improve the skin condition of patients, reduce complication risks, and improve patient satisfaction with gastrointestinal surgery in managing peristomal dermatitis. Although future research is warranted with a broader scope of evaluation indicators and longer-term follow-up observations, the current study provides valuable preliminary guidance for optimal clinical intervention protocols for patients with peristomal dermatitis, ultimately improving patient outcomes.