The impact of preoperative stoma education on postoperative outcomes for patients with new stomas after colorectal surgery: a systematic review and meta-analysis

Tech Coloproctol. 2025 Oct 17;29(1):183. doi: 10.1007/s10151-025-03213-4.

Abstract

Background: In accordance with Enhanced Recovery After Surgery (ERAS) principles, it has recently been suggested that preoperative stoma education protocols be routinely introduced in perioperative care. Potential benefits of such programs include shorter postoperative length of stay (LOS) and decreased readmission following discharge. We designed this systematic review and meta-analysis to further investigate the effect of preoperative stoma education on postoperative outcomes.

Methods: A search in MEDLINE, Embase, and CENTRAL from inception to February 2024 was performed. We included randomized controlled trials or observational cohort studies evaluating patients who underwent stoma formation during colorectal surgery and compared those receiving and not receiving preoperative stoma education. Main outcomes included stoma-related morbidity, peristomal complications, overall morbidity, postoperative LOS, readmission, and quality of life (QoL). Meta-analyses were performed using inverse variance random effects models.

Results: Nine studies (four randomized studies and five cohort studies) met inclusion criteria. Overall, 507 patients (mean age: 60.95 ± 12.86 years, 40.1% female) received preoperative stoma education prior to stoma formation, and 356 patients (mean age: 61.75 ± 12.31 years, 39.2% female) did not. Meta-analysis showed that peristomal skin complications were significantly reduced with preoperative stoma education (two studies, 9.5% versus 19.4%, risk ratio (RR) 0.45, 95% confidence interval (CI) 0.29-0.72, p < 0.01, I2 = 0%).There were no significant differences in other outcomes, and there was insufficient available data for meta-analysis of stoma-related morbidity or QoL.

Conclusions: This study presents very low-certainty evidence suggesting that preoperative stoma education may reduce peristomal skin complications, but otherwise no significant clinical benefits were identified. Future prospective studies are warranted to further investigate the impact of preoperative stoma education.

Prospero registration: CRD4202451323.

Keywords: Colorectal surgery; Colostomy; Digestive system surgical procedures; Ileostomy; Wound, ostomy, continence nurse.

Publication types

  • Systematic Review
  • Meta-Analysis
  • Review

MeSH terms

  • Aged
  • Colostomy*
  • Enhanced Recovery After Surgery
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Education as Topic* / methods
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control
  • Preoperative Care* / methods
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Surgical Stomas* / adverse effects
  • Treatment Outcome