Ileostomy reversal rates and outcomes in a regional centre: a 5-year cohort study

Summary Background Ileostomy reversal restores bowel continuity and quality of life. This is usually performed within 3 to 6 months following the initial procedure but is often delayed in regional centres due to limited surgical capacity and resource constraints. This study evaluated outcomes and predictors of morbidity for ileostomy reversals in an Australian regional centre. Methods A retrospective review was performed for all ileostomy reversals undertaken between April 2020 and April 2025. Data included demographics, perioperative characteristics, time to reversal, booking interval, length of stay (LOS), and 30-day outcomes. Primary endpoint was the postoperative complication rate; secondary outcomes were length of stay, readmission, and mortality. Univariable comparisons used χ 2 , Fisher’s exact, and non-parametric tests. Multivariable logistic regression identified independent predictors of morbidity. Results A total of 112 patients underwent reversal; median age was 63.5 years and 75.9% had loop ileostomies. Median time to reversal was 255 days, and the booking-to-procedure interval was 72 days. Core postoperative complications occurred in 42.9%, most commonly ileus (13.4%) and wound infection (7.1%). End ileostomy reversal was associated with substantially higher complication rates than loop reversal (70.8% vs. 34.1%), with adjusted predicted complication probabilities of 68% and 34%, respectively. In multivariable analysis, time to reversal (odds ratio [OR] 1.07 per 30 days; p = 0.009), age (OR 1.04/year; p = 0.013), and operative duration (log-transformed OR 7.53; p < 0.001) independently predicted complications. Median LOS was 5 days; 30-day readmission was 16.1%, and mortality was 1.8%, both occurring only in patients with complications. Conclusion For ileostomy reversals, increasing delay from the index surgery heightens the postoperative risk. End ileostomy reversal represents a distinct high-risk subgroup, with substantially greater morbidity and longer hospital stay than loop ileostomy reversal. Reducing diversion duration and prioritising high-risk patients may improve outcomes.