The impact of preoperative stoma education on postoperative outcomes for patients with new stomas after colorectal surgery: a systematic review and meta-analysis
Bibliographic record
Abstract
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. 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. 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, I 2 = 0%).There were no significant differences in other outcomes, and there was insufficient available data for meta-analysis of stoma-related morbidity or QoL. 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. CRD4202451323
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.026 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.046 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".