Relationship between ostomy caregiver skill proficiency and one-month risk of ostomy complications in patients with colorectal cancer: A cohort study.

Abstract

Background Stoma-related complications often occur after ostomy, with an incidence of 21-70%. Clinical nursing mainly focuses on improving ostomy caregiver skill proficiency to reduce the occurrence of complications, but the specific relationship between caregiver competency proficiency and the incidence of stomatal complications is often overlooked. This study aims to evaluate the current status of ostomy caregiver skill proficiency among the caregivers of rectal cancer patients after surgery and to examine how these skills correlate with the risk of ostomy complications within the first month after surgery. This prospective study enrolled patients who underwent rectal cancer surgery with an ostomy between January 2022 and April 2024 and had no ostomy complications at discharge, together with their designated primary ostomy caregivers. Minimum discharge standards for home care of new ostomy patients were used as the evaluation tool to evaluate ostomy caregiver skill proficiency. The incidence of ostomy complications was followed up one month after surgery. Analysis of variance (ANOVA), the Cochran-Armitage test, and restricted cubic spline were used for statistical analysis. Of 200 recruited patients and caregivers, 188 (94.0%) were included in the analysis. Ostomy caregiver skill proficiency was evaluated using WOCN consensus-based discharge criteria (range: 7-25), classifying 29 patients (15.4%) as low-skill (≤15), 123 (65.4%) as medium-skill (16-20), and 36 (19.1%) as high-skill (>20). During the first month post-discharge, 66 patients (35.1%) developed ostomy complications, defined as peristomal skin irritation, leakage, pouch-related issues, stoma retraction, or prolapse. Complication rates decreased with higher caregiver skill proficiency levels (75.9%, 30.1%, 19.4%; p < 0.001). Both the high-skill (adjusted odds ratio: 0.082) and medium-proficiency (adjusted odds ratio: 0.135) groups exhibited significantly low risk of complications. A restricted cubic spline curve further confirmed a significant nonlinear dose-response relationship between ostomy caregiver skill proficiency and the risk of ostomy complications in the first month after surgery (p= 0.021). Receiver operating characteristic curve analysis showed an area under the curve of 0.719 (95% CI:0.637-0.800), indicating moderate predictive ability. Higher levels of ostomy caregiver skill proficiency were associated with a substantially lower risk of early postoperative ostomy complications. Although the predictive performance was moderate, caregiver skill assessment may provide useful information for early risk identification and targeted intervention. These findings highlight the importance of strengthening caregiver training to improve early postoperative outcomes and suggest a potential skill threshold that may help clinicians identify patients at higher risk. Further validation in larger, multicenter studies is warranted.