Retrospective Cohort Study on the Effect of Professional Nursing Intervention on Clinical Outcomes after Colostomy in Middle-aged and Elderly Patients

Summary

A retrospective evaluation of a standardized, multi-module nursing intervention for middle-aged/elderly colostomy patients revealed greater 1 month improvements in self-care, psychological status, and quality of life, along with fewer complications and higher nursing satisfaction compared to routine care. The findings support the adoption of structured, nurse-delivered post-colostomy care.

Abstract

Colostomy substantially affects daily function and psychosocial status, and middle-aged and elderly patients often experience reduced self-care ability, heightened anxiety/depression, and early complications. This single-center retrospective cohort evaluated whether a standardized, professional nursing pathway improves short-term outcomes after colostomy compared with routine care. We analyzed 80 consecutive patients who underwent colostomy between January 2022 and December 2023 and received either routine care (n = 40) or a multi-module pathway (n = 40) integrating structured education, standardized stoma and peristomal skin care, individualized lifestyle/diet guidance, nurse-led brief cognitive-behavioral support, and scheduled follow-up. Outcomes at baseline and post 1 month included self-care ability (Self-Care Ability Assessment Scale, ESCA), anxiety (Self-Rating Anxiety Scale, SAS), depression (Self-Rating Depression Scale, SDS), quality of life (City of Hope Quality of Life-Ostomy Questionnaire, COH-QOL-OQ), complication rates (e.g., stoma infection, stenosis), and nursing satisfaction assessment. Compared with routine care, the professional-care group showed significantly greater improvements in ESCA and COH-QOL-OQ and larger reductions in SAS/SDS (all p < 0.05), along with lower early complication rates and higher nursing satisfaction. This real-world data suggests that a standardized, nurse-delivered post-colostomy pathway improves short-term clinical and patient-reported outcomes in middle-aged and elderly patients.

Introduction

Colostomy (a form of enterostomy) is widely used in the management of rectal and colon cancers, creating an abdominal opening that diverts fecal flow and restores defecation when the distal bowel is diseased or obstructed^1,2. While the procedure addresses oncologic and functional indications, it also reshapes daily living. The impact can be especially pronounced in middle-aged and elderly patients, whose recovery may be slower due to age-related physiological decline and multimorbidity³.

Beyond physical adaptation, long-term reliance on an ostomy pouch can im....

Protocol

The study obtained institutional ethics approval before any data abstraction and ensured de-identification of all records (Approval No.: 2023-YZ-061). Written informed consent was obtained from all participants prior to data collection and follow-up. All procedures complied with institutional infection-prevention and privacy policies throughout care delivery and data handling.

Materials and equipment

Prepare two- or one-piece ostomy pouches (flat and convex), skin barriers, moldable rings, adhesive aids and removers, protective film or powder, ostomy scissors, a stoma measuring guide, sterile 0.9% saline, gauze, gl....

Results

Clinical characteristics (Table 1)

A total of 80 eligible patients were included and categorized retrospectively according to actual care received. Baseline characteristics were well balanced: there were no significant between-group differences in age, sex, ostomy appliance type, residence, educational level, or household income (all p > 0.05; Table 1). Descriptive statistics are provided as.......

Discussion

Colostomy can restore bowel function for patients with colorectal disease but disrupts daily life and psychosocial well-being, particularly in middle-aged and elderly patients with comorbidities¹⁷. This study found that, compared with routine care, a standardized, multi-module professional nursing pathway was associated with greater 1 month improvements in self-care ability (ESCA), psychological status (SAS; SDS)¹⁸, and quality of life (COH-QOL-OQ), alongside lower early co.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
0.9% sodium chloride solution (sterile)	West China Hospital (pharmacy/clinical supply)	N/A	Used for peristomal cleaning (30–50 mL) when saline chosen.
Barrier ring (moldable)	Hollister Incorporated	8805	Reinforcement to prevent leakage; used in escalation and routine fitting.
City of Hope Quality of Life–Ostomy Questionnaire (COH-QOL-OQ)	Published instrument (see Methods/References)	published scale	Outcome measure at baseline and 1 month; total + domain scores.
Complication log / quality-control log forms	In-house (Colorectal Cancer Center nursing team)	In-house forms	Record leakage, skin issues, infection/stenosis/bleeding/high-output events; supports 10% audit.
Disposable gloves (non-sterile examination gloves)	West China Hospital (clinical supply)	N/A	For pouch change and skin care procedures.
Electronic medical record (EMR) access for data abstraction	Institutional EMR system	N/A (institutional system)	Retrospective extraction of baseline variables, complications, and follow-up documentation; de-identified.
Follow-up schedule/checklist	In-house (Colorectal Cancer Center nursing team)	In-house form	Week-1 tele follow-up; week-2 and week-4 clinic/video review; outcome collection.
IBM SPSS Statistics 25.0	IBM	IBM SPSS Statistics v25.0	Used for statistical analyses (t-test/Mann–Whitney, χ²/Fisher, ANCOVA/regression, etc.).
Medical adhesive remover (wipes/spray)	Hollister Incorporated	Wipes: 7760; Spray: 7731 (also 7737)	Facilitates atraumatic pouch/barrier removal during changes.
New Image Flat Skin Barrier / Wafer (Flextend; baseplate)	Hollister Incorporated	14706	Cut opening 1–2 mm larger than stoma diameter; press 1–2 min to secure.
New Image Two-Piece Drainable Ostomy Pouch (flat system; pouch component)	Hollister Incorporated	18182; 18192; alternatives without filter: 18112; 18132	Alternative pouching system; baseplate changed per schedule.
New Image Two-Piece Drainable Ostomy System (convex option: drainable pouch + soft convex skin barrier)	Hollister Incorporated	Pouch: 18182/18192; Convex skin barrier: 11402	Convex baseplate for improved seal when indicated.
Ostomy scissors (blunt-tip, curved recommended)	West China Hospital (ward equipment/CSSD)	N/A	For cutting baseplate opening to measured size.
Patient education handouts (printed)	In-house (Colorectal Cancer Center nursing team)	In-house document	Given at discharge; includes pouch-change steps, red-flags, contacts.
Patient education visual/audiovisual materials	In-house (Colorectal Cancer Center nursing team)	In-house media	Used during pre-discharge sessions; supports demonstrations.
Premier One-Piece Drainable Ostomy Pouch (convex, CeraPlus; size per patient)	Hollister Incorporated	8914; 8990	Convex option used for leakage/fit issues and escalation steps.
Premier One-Piece Drainable Ostomy Pouch (flat, Lock ’n Roll closure; size per patient)	Hollister Incorporated	8331	Used for routine/per-pathway patients as clinically indicated; flat option. Example product: Hollister Premier™ One-Piece Drainable Ostomy Pouch (flat).
Psychological support tracking card	In-house (Colorectal Cancer Center nursing team)	In-house form	Documents weekly 15-min sessions + daily pleasant activity adherence.
Seal/adhesive aids (paste and barrier extenders/strips)	Hollister Incorporated	Skin barrier paste: 79301; Barrier extenders: 79402	Seal-enhancing accessory; use per skin condition and leakage risk.
Self-Care Ability Assessment Scale (ESCA) questionnaire	Published instrument (see Methods/References)	published scale	Outcome measure at baseline (T0) and 1 month (T1).
Self-Rating Anxiety Scale (SAS) questionnaire	Published instrument (see Methods/References)	published scale	Outcome measure at baseline and 4 weeks.
Self-Rating Depression Scale (SDS) questionnaire	Published instrument (see Methods/References)	published scale	Outcome measure at baseline and 4 weeks.
Six-step pouch-change checklist	In-house (Colorectal Cancer Center nursing team)	In-house form	Checklist steps: cut, clean, measure, apply, press, check; used for return demonstration.
Skin protective film (barrier film / no-sting protective wipes)	Hollister Incorporated (or equivalent skin barrier film)	7917 (Adapt No Sting Skin Protective Wipes)	Applied to protect peristomal skin; used routinely or during erythema/escalation.
Sterile gauze pads	West China Hospital (clinical supply)	N/A	For drying/cleaning peristomal area after saline/water cleansing.
Stoma measuring guide	West China Hospital (ward supply; often included with pouch kits)	N/A	For measuring stoma diameter before cutting baseplate.
Stoma powder (peristomal skin barrier powder)	Hollister Incorporated	7906 (Adapt Stoma Powder)	Used when moisture-associated skin damage/erosion present; paired with barrier film if needed.
Tele-follow-up tools (telephone/video call device)	Patient and nursing team devices		Used for week-1 phone follow-up and video reviews when applicable.
Thermometer	West China Hospital (ward equipment) / patient home device	N/A	To detect fever threshold ≥38°C as red-flag sign.
Warm water (cleaning)	Clinical setting (patient home or ward)	N/A	Alternative cleaning fluid; avoid irritants/soap residue.
Wound swab for culture (sterile)	West China Hospital (microbiology lab/clinical supply)	N/A	Used if infection suspected (pain/heat/purulent drainage/fever ≥38°C) to obtain swab/culture.