EP192 - Effect of Early vs. Delayed Ostomy Reversal in Patients Undergoing Colorectal Surgery

Purpose/Background: Fecal diversion is commonly performed to manage conditions such as diverticulitis, colon perforation, inflammatory bowel disease, and gastrointestinal malignancy. Ideally, ostomy creation is followed by a reversal procedure to restore bowel continuity. Ostomy reversal is considered safe within 4–6 months after the initial surgery, allowing postsurgical inflammation to subside and minimize complications related to intra-abdominal adhesions. Delays beyond six months have been associated with increased postoperative complications, including surgical site infection, ileus, reoperation, prolonged hospital stay, readmission, and the need for a new ostomy. Patient factors such as age, BMI, ASA classification, and functional status may also influence reversal timing and outcomes. This study evaluates postoperative complications among patients undergoing delayed ostomy reversal and examines preoperative risk factors influencing reversal timing.

Methods/Interventions: A retrospective observational study was conducted of patients who underwent ostomy reversal between 2020 and 2025. Patient characteristics—including age, sex, functional status, ASA classification, comorbidities (hypertension, diabetes, COPD), intraoperative wound classification, and surgical urgency—were reviewed. The primary outcome was the incidence of postoperative complications. The secondary outcome was identification of risk factors associated with delayed reversal. Factors related to reversal timing were analyzed using Student’s t-test and chi-squared tests. Complication rates were compared between our institution and statewide data (using the Michigan Surgical Quality Collaborative database).

Results/Outcomes: The mean time to ostomy reversal was 194 days. Of the 96 patients meeting inclusion criteria, 43.4% had delayed reversal (>168 days), while 27.3% had early reversal ( < 112 days). The most common complication among delayed reversals was readmission, occurring in 15 patients (14%). There were no significant differences in baseline characteristics between the early and delayed groups, except that a higher proportion of delayed reversals occurred in female patients (70% vs. 46%, p = 0.05). Few complications occurred in the early reversal group; one patient experienced a surgical site infection (p = 0.435) and one required a new ostomy (p = 0.486). Multivariable analysis did not identify significant predictors of readmission after reversal. Complications following the initial ostomy creation were associated with delayed reversal, and the presence of sepsis further prolonged the interval to reversal (p = 0.069). Postoperative complication rates after delayed reversal at our institution were not significantly different from statewide data.

Conclusion/Discussion: Delayed ostomy reversal is associated with higher postoperative complication and readmission rates compared to early reversal. Patient characteristics influence reversal timing and outcomes. Early reversal should be encouraged in patients at risk for postoperative complications, and further strategies should be implemented to optimize outcomes.