S489 Predictors of Ostomy and Outcomes in Colonic Stenting for Obstructing Colon Cancer

Introduction: In colonic stenting, a self-expandable metallic stent (SEMS) is introduced in the colon to alleviate the obstruction. However, in some cases, the need for ostomy may arise, impacting their survival. Patients with colon cancer are at risk of intestinal obstruction, which may necessitate such interventions. This study aimed to evaluate the incidence of ostomy among colonic stenting procedures in colon cancer patients, factors that contributed to such procedures, and their all-cause-in-hospital death rate. Methods: Adults with colon cancer and suffering from intestinal obstruction who were hospitalized for colonic stenting were studied through de-identified records compiled as the National Inpatient Sample. A multivariable logistic regression model was created to analyze various factors that could have influenced the need for ostomy creation. The mortality rate among those undergoing ostomy was also estimated. Results: We identified 3,555 cases of colon cancer who underwent colonic stenting between 2016 and 2021. The mean age of the sample was 65.0 years. Approximately 12.8% (455 cases) required ostomy procedures. Further analysis found that patients who were hospitalized on an elective basis, treated at urban teaching or non-teaching centers(vs rural), had suffered weight loss or were diagnosed with obesity, or had a history of chronic kidney disease, or liver cirrhosis, were more likely to undergo ostomy procedures. Meanwhile, women (vs men), patients with dementia, dyslipidemia, racially classified as Blacks (vs Whites), or with metastasis had lower odds of such procedures. No discrepancies were seen based on their insurance form and other comorbidities. The need for ostomy resulted in longer hospitalizations (mean stay of 15.52 days vs 7.35, P < 0.01), with higher hospital charges ($240,559 vs $90,496, P < 0.01). Around 11.0% (vs 3.2%) of ostomy patients did not survive, which affected an older group (mean age 71.20 vs 65.57 years, P < 0.01), with a higher mean Charlson Comorbidity Index score (5.80 vs 4.94, P= 0.017). Conclusion: Colon cancer patients undergoing colonic stenting for obstruction may require ostomy that can be influenced by the sex of the patients, the location of the hospital, and various comorbidities. Ostomy in older patients who are sicker may also lead to poorer outcomes. Therefore, physicians must conduct meticulous pre-operative screening and adopt thorough post-operative follow-ups during their stay.