Conclusions and Summary
Ostomy surgery presents both clinical and quality of life challenges to patients living with permanent ostomies. Attention to pre-surgery and postoperative patient education and care are key factors in successful outcomes.

In the first paper, Kariv et al tested the potential for a strict “fast track” protocol to reduce the cost of care while not compromising clinical outcomes for ileostomy patients. The fast track protocol included pre-operative patient education on the procedures and protocols so that patients would know what to expect and what milestones they would be asked to achieve. The cornerstone of this protocol included early dietary intake regardless of evidence of bowel function post-surgery and physical activity. This group has conducted related research in the past, which may have influenced practices within their respective facilities to improve outcomes regardless of the strict use of the fast track protocol.

Patients in this study included 97 well-matched treatment and control group patients. Patients were matched for demographics and surgical procedures. Differences were seen in the length of stay when compared to a control group and a reduction in costs that are associated with a longer hospital stay. There were no significant differences between the fast track and control groups for rates of readmission and complications, suggesting that the fast track protocol was as safe as the less structured pathways followed for by control group patients.

In the second paper, Haugen et al explored the factors that may affect the ability of patients to successfully adjust to a permanent incontinent ostomy. This study included the survey of ileostomy, colostomy, and urostomy patients. The two most prominent factors associated with improved long-term adjustment appeared to be the perceived helpfulness of education and problem-solving support from a wound care ostomy (WOC) nurse and ongoing illness. The most prominent factor reducing adjustment scores was anxiety over access to and cost of ostomy supplies.

The categories of adjustment identified during the study included factors related to pouches, assistance from the WOC nurse, and changes in several activities. Common concerns were expressed about independence in self-care, concern for relationships, and interference with usual activities. Patients who had higher adjustment and quality of life scores felt that their interaction with a WOC nurse was helpful. The second most significant factor of ongoing illness may have reflected the patient’s perception that the ostomy contributed to their survival and the relief of symptoms from their ongoing disease. The authors suggested that a strong emphasis on preparation and follow-up with a WOC nurse, including advocacy for access and reimbursement for ostomy supplies, could improve long-term adjustment to living with an ostomy.

The third paper by Krouse et al compared differences in quality of life outcomes for cancer and non-cancer patients living with colostomies. The primary differences seen in this study were a significantly lower quality of life score in physical, psychological, and social items both before and after adjustment for gender and age. Most notably, a larger proportion of the non-cancer patients noted moderate to severe fatigue, sleep disruption, aches and pains, dissatisfaction with appearance, anxiety, depression, difficulty in caring for an ostomy, problems with personal relationships, and financial burden. The only area of additional compromise for cancer colostomy patients was in the lack of perceived positive changes with their surgery.

While many of the differences could be at least partially explained by ongoing disease in the non-cancer group, the authors suggested that the results could assist ostomy care specialists in focusing on the issues that affect quality of life. Another study showed improvements in adjustment and rehabilitation with pre-operative patient education and the authors of this study suggested that access to appropriately informed surgeons and nurses is likely to have a significant impact on quality of life outcomes.