Predictors of clinically significant complications after stoma reversal: A prospective analytical study

Table 1 Baseline demographic, clinical, operative characteristics (n = 115), n (%)/mean ± SD/median (interquartile range)

Variable
Demographic characteristics
Age (years)	34.7 ± 15.0
Median age	32 (13-70)
Age group distribution (years)
< 20	23 (20.0)
20-29	30 (26.1)
30-39	18 (15.7)
40-49	20 (17.4)
50-59	15 (13.0)
≥ 60	9 (7.8)
Sex
Male	71 (61.7)
Female	44 (38.3)
BMI (kg/m2)	20.0 ± 2.1
Median BMI	19.4 (15.2-27.2)
Aetiology of index surgery
Tuberculosis	49 (42.6)
Typhoid perforation	33 (28.7)
Others	12 (10.4)
Large bowel obstruction	8 (7.0)
Appendicular perforation	7 (6.1)
Trauma	6 (5.2)
Type of stoma
Loop ileostomy	63 (54.8)
Double-barrel ileostomy	36 (31.3)
End ileostomy	9 (7.8)
Colostomy	7 (6.1)
Type of anastomosis
Single-layer extra mucosal	24 (20.9)
Double-layer	69 (60.0)
Stapled	22 (19.1)

BMI: Body mass index.

Table 2 Univariate analysis of operative predictors of hospital stay

Variable	Coefficient (β)	SE	t value	P value	95%CI	R2
Stoma type (complexity)	0.18	0.12	1.52	0.13	-0.05 to 0.41	0.02
Etiology	0.03	0.08	0.32	0.75	-0.14 to 0.19	0.00
Waiting time to reversal (months)	0.11	0.06	1.75	0.08	-0.01 to 0.24	0.03
Anastomosis time (minute)	0.05	0.01	3.47	0.0007	0.02 to 0.08	0.10
Type of anastomosis	-0.14	0.16	-0.87	0.39	-0.46 to 0.18	0.01

Table 3 Univariate analysis of patient-related predictors of hospital stay

Variable	Coefficient (β)	SE	t value	P value	95%CI	R2
Age (years)	0.033	0.013	2.55	0.012	0.007 to 0.059	0.054
BMI (kg/m2)	-0.159	0.095	-1.67	0.098	-0.347 to 0.030	0.024
Sex (male = 1)	-0.794	0.414	-1.92	0.057	-1.614 to 0.025	0.032
Pre-op hemoglobin (g/dL)	-0.571	0.213	-2.68	0.0085	-0.994 to -0.149	0.060
Pre-op albumin (g/dL)	-1.372	1.110	-1.24	0.219	-3.571 to 0.827	0.013

BMI: Body mass index.

Table 4 Multivariate analysis of predictors of hospital stay

Variable	Coefficient (β)	SE	P value	95%CI
Stoma type (complexity)	0.48	0.24	0.047	0.01-0.96
Etiology	-0.26	0.17	0.144	-0.60 to 0.09
Waiting time to reversal (months)	0.19	0.14	0.167	-0.08 to 0.46
Anastomosis time (minute)	0.08	0.03	0.018	0.01-0.15
Type of anastomosis	0.24	0.37	0.525	-0.50 to 0.98

Table 5 Predictors of postoperative morbidity-univariate analysis of predictors of Clavien-Dindo score

Variable	Coefficient (β)	SE	P value	95%CI	R2
Stoma type (complexity)	0.0635	0.0311	0.043	0.0018-0.1252	0.036
Etiology	0.0235	0.0219	0.286	-0.0199 to 0.0669	0.010
Waiting time to reversal	0.0088	0.0168	0.599	-0.0245 to 0.0421	0.003
Anastomosis time (minute)	0.0107	0.0037	0.005	0.0033-0.0180	0.070
Type of anastomosis	-0.0218	0.0430	0.613	-0.1068 to 0.0632	0.002

Table 6 Predictors of postoperative morbidity-multivariate analysis of predictors of Clavien-Dindo score

Variable	Coefficient (β)	SE	P value	95%CI
Anastomosis time (minute)	0.051	0.018	0.004	0.017-0.086
Stoma type	0.15	0.12	0.227	-0.09 to 0.39
Etiology	-0.05	0.09	0.561	-0.23 to 0.13
Waiting time to reversal	0.04	0.07	0.547	-0.10 to 0.18
Type of anastomosis	0.15	0.19	0.417	-0.22 to 0.53

Table 7 Summary of studies on small intestinal perforation and ileostomy reversal

Ref.	Study design, number of cases	Objective	Results	Remarks
Kang et al[7], 2020	Retrospective multicenter cohort; 437 HP, 127 reversals	Evaluate rate of Hartmann’s reversal and predictors of post-reversal complications	35.9% post-reversal of Hartmann’s procedure complications. Interval > 6 months associated with lower complication rate. Age > 70, ASA III-IV, malignancy predicted non-reversal	Delay > 6 months may reduce complications; patient comorbidity critical
Pokorny et al[9], 2005	Retrospective cohort; 533 closures	Identify predictors of mortality and complications after stoma closure	Mortality 3%; complication rate 20%. Age predicted mortality; silicone drain use predicted complications	Age significant predictor; drain use associated with morbidity
Liang et al[21], 2013	Retrospective; 128 reversals	Identify predictors of SSI after stoma reversal	SSI rate 36%. Independent predictors: Fascial dehiscence (OR = 16.9), colostomy, thicker subcutaneous fat	Strong predictive model for SSI risk stratification
de Paula et al[12], 2020	ACS-NSQIP database analysis	Identify predictors of morbidity after elective ileostomy closure	Significant morbidity; operative time and patient factors predictive	Large database; risk-adjusted predictors identified
McCain et al[11], 2026	NSQIP database analysis	Identify predictors of major complications and mortality after colostomy reversal	Predictors: Age > 70, BMI ≥ 40, smoking, COPD, dependent status, steroid use, dialysis. Open approach ↑ complications (OR 1.67)	Robust national data; highlights modifiable risk factors
Lv et al[10], 2024	Retrospective; 439 patients	Identify predictors of overall and stoma-related complications after ileostomy reversal	Overall complications 11.4%. Low albumin → overall complications. High BMI and longer interval → stoma-related complications	Nutritional status and delay are key predictors
Khoo et al[16], 2021	Retrospective cohort; 251 patients	Assess impact of timing of reversal on outcomes	Early (< 6 months) reversal had lower POI (13.5% vs 38.1%) and fewer 30-day complications	Delay increases morbidity; supports early reversal
Rubio-Perez et al[18], 2014	Institutional retrospective study	Assess impact of delayed protective ileostomy closure	Delayed closure associated with increased postoperative complications	Timing is modifiable risk factor
Munshi et al[17], 2025	Multicenter retrospective cohort	Evaluate effect of delay on 90-day complications	Delayed reversal independently associated with higher complication rates	Multicenter validation of timing effect
Popazu et al[19], 2025	Retrospective; 148 HP reversals	Compare early vs delayed Hartmann reversal	Early (45-120 days) → fewer complications, shorter stay. Late reversal independently associated with complications	Supports early reversal when feasible
Oriel et al[22], 2017	Retrospective cohort; 114 reversals	Identify incidence and risk factors for hernias after stoma reversal	Incisional hernia 317%; risk factors: BMI, ASA ≥ 3, radiotherapy, deep SSI	Hernia risk stratification important for long-term outcomes
Tirelli et al[20], 2023	Retrospective; 126 patients	Identify predictors of Clostridium difficile infection after stoma reversal	CDI 4.8%; delayed reversal associated with higher CDI risk	Timing influences infectious morbidity
Peltrini et al[23], 2023	Retrospective; 145 patients	Evaluate postoperative morbidity after loop ileostomy reversal	Significant morbidity; risk influenced by urgency of primary surgery	Differentiates elective vs urgent index surgery
Abdulmohaymen[14], 2020	Prospective; 70 patients	Compare loop ileostomy vs loop colostomy complications including reversal	Higher reversal-related complications in ileostomy group (45.4% vs 13.5%)	Stoma type impacts reversal morbidity
Özcan et al[24], 2025	Retrospective cohort	Compare early vs late ileostomy closure complications	Evaluates complication rates based on timing	Adds evidence on timing-related morbidity

SSI: Surgical site infection; ACS-NSQIP: American College of Surgeons National Surgical Quality Improvement Program; COPD: Chronic obstructive pulmonary disease; BMI: Body mass index; ASA: American Society of Anesthesiologists; OR: Odds ratio; POI: Postoperative ileus; CDI: Clostridium difficile infection.