Increased Odds of Perioperative Complications Following Lumbar Diskectomy Among Patients With a Colostomy

INTRODUCTION: Lumbar diskectomy is a commonly performed surgery for which patients may present with conditions predisposing to adverse outcomes, such as the presence of a colostomy. This study aimed to characterize patients undergoing lumbar diskectomy with versus without colostomy and determine whether matched cohorts had differential rates of postoperative complications. METHODS: Adult patients undergoing primary lumbar laminotomy/diskectomy were identified from the administrative 2010 to 2022 Q4 PearlDiver M165 database. Two subcohorts were created: (1) patients with a diagnosis code for colostomy without any history of ostomy reversal procedures and (2) patients without colostomy. Those with versus without colostomy were matched and compared for incidence of 90-day postoperative adverse events or secondary surgery within 5 years using multivariable logistic regression, controlling for patient age, sex, and Elixhauser Comorbidity Index (ECI). RESULTS: Of 365,161 lumbar diskectomy patients, colostomy was present for 355. Following matching, colostomy patients were at higher odds of sepsis (odds ratio [OR] 14.52, P < 0.0001), surgical site infection (OR 6.92, P < 0.0001), wound complications (OR 8.85, P < 0.0001), acute kidney injury (OR 5.26 P < 0.0001), urinary tract infection (OR 4.72, P < 0.0001), pneumonia (OR 3.92, P = 0.0002), as well as 5-year revision lumbar surgeries (OR 2.85, P < 0.0001). CONCLUSION: Colostomies are rarely present at the time of lumbar diskectomy, but when present are associated with higher odds of perioperative adverse outcomes (mostly infectious) and 5-year revision lumbar surgeries. These findings may help guide shared decision making and development of risk mitigation strategies.