Predicting early mortality in palliative stoma for obstructing cancer: A 6‐year review

Abstract Objective It has often been a difficult decision whether palliative stoma creation is beneficial for patients with advanced colorectal cancer. In this study, we aim to identify factors associated with 90‐day all‐cause mortality in patients with obstructing colorectal cancer undergoing palliative colostomy, and to evaluate the predictive value of the Surgical Outcomes Monitoring and Improvement Programme (SOMIP) score, with the aim of facilitating surgical decision‐making for terminal patients. Methodology Emergency palliative colostomies for obstructive colorectal cancer performed at Queen Elizabeth Hospital between January 2018 and December 2023 were retrospectively reviewed in this case–control study. Three‐month survivors and non‐survivors were compared across various parameters. Results Sixty‐one patients were included, all of whom underwent transverse colostomy, with a 90‐day mortality rate of 25.8%. Factors associated with 90‐day mortality were operation via midline laparotomy ( P = .045) and albumin level ( P = .015). In a binary logistic regression model, patients who underwent laparotomy had higher 90‐day mortality (odds ratio 6.06, P = .046), whereas those with higher albumin levels had lower 90‐day mortality (odds ratio 0.88, P = .021). The SOMIP score achieved an area under the curve of 0.735 in predicting all‐cause 90‐day mortality, and a cut‐off score of 9.45 provided a sensitivity of 87.5% and a specificity of 62.2%. Conclusions Our study demonstrated that patients with an SOMIP score higher than 9.45 may have a higher risk of 3‐month mortality. Among all parameters, albumin showed the clearest association with early mortality. Where feasible, avoiding unnecessary laparotomy during palliative stoma creation might also improve 3‐month survival.