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 impose psychological burdens-such as stigma, lowered self-esteem, anxiety, and depressive symptoms-which interact with practical challenges of stoma self-management⁴. Inadequate stoma and peristomal skin care further increases the risk of early complications (e.g., wound infection, peristomal dermatitis, stenosis), prolonging recovery and worsening patient experience^5,6. These realities underscore the central role of nursing in supporting safe self-care, complication prevention, and reintegration into daily life⁷.

However, conventional nursing approaches are often fragmented, insufficiently parameterized, and slow to detect subtle physical or psychological changes, which may lead to suboptimal outcomes⁸. Reports on comprehensive/continuing ostomy nursing have highlighted these gaps and the need for standardized, multi-component pathways^9,10.

This study evaluates a standardized, multi-module professional nursing pathway tailored to middle-aged and elderly colostomy patients, parameterized with explicit frequencies, durations, red-flag thresholds, and follow-up checkpoints. This population-focused, pathway-based evaluation in a real-world retrospective cohort provides practice-proximal evidence linking concrete nursing modules to validated outcomes.

In a single-center retrospective analysis (January 2022-December 2023), we compared 1 month outcomes between patients receiving routine care and those receiving the professional pathway. Outcomes included self-care ability (Self-Care Ability Assessment Scale, ESCA)¹¹, anxiety (Self-Rating Anxiety Scale, SAS)¹², depression (Self-Rating Depression Scale, SDS)¹³, quality of life (City of Hope Quality of Life-Ostomy Questionnaire, COH-QOL-OQ)¹⁴, complication rates¹⁵, and nursing satisfaction¹⁶.

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, gloves, printed and audiovisual education materials, tele-follow-up tools, and quality-check forms.

Study design and groups (Retrospective)

An overview of the retrospective study design, cohort assignment, and assessment time points is shown in Figure 1. Identify all eligible patients aged ≥45 years who underwent colostomy between January 2022 and December 2023 at the study center. Apply predefined inclusion and exclusion criteria as follows, and confirm availability of baseline and 1-month outcome records. Include patients aged ≥45 years who underwent colostomy at the study center between January 2022 and December 2023 and had complete baseline records and documented 1-month follow-up outcome assessments. Exclude patients with missing key baseline variables or 1-month outcomes, those who underwent stoma reversal or major reoperation within 1 month, those unable to complete the ESCA/SAS/SDS/COH-QOL-OQ assessments due to severe cognitive/communication impairment, and those transferred to another facility or lost to follow-up before the 1-month assessment. Categorize patients according to the care they actually received into a routine-care cohort and a professional-pathway cohort; note that grouping reflects real-world practice rather than random assignment.

Pre-discharge education

Provide two one-to-one education sessions of 15-20 min each, spaced at least 24 h apart. Explain ostomy anatomy and function, daily self-care steps, red-flag signs and actions, diet and activity progression, and indications for contacting the care team. Demonstrate pouch change and require a complete return demonstration using a six-step checklist (cut, clean, measure, apply, press, check). Issue printed and visual materials and set the target of independent pouch change in ≤20 min without missed steps. Verify mastery before discharge.

Stoma and peristomal skin care

Replace the pouch every 3-5 days or as soon as leakage occurs. Cut the baseplate opening 1-2 mm larger than the stoma diameter, apply the system, and press evenly for 1-2 min to secure adhesion (or follow manufacturer instructions where they differ). Clean the peristomal area with 30-50 mL of warm water or 0.9% saline and avoid irritants or soap residue. Position the patient to minimize contamination during changes; trim hair if required to improve sealing. Verify that the appliance remains leak-free for ≥72 h and that the peristomal skin is intact, dry, and free of an erythematous rim >1 cm. If erythema exceeds 1 cm, if moisture-associated damage or erosion is present, or if there is suspected infection (pain, heat, purulent drainage, or fever ≥38 °C), escalate care promptly: reinforce with barrier film plus convex system and ring and reassess within 48 h; obtain a wound swab/culture and arrange same-day surgical review when infection is suspected. If stenosis is suspected due to pencil-thin output or obstructive symptoms, arrange a colorectal assessment within 48 h and avoid forceful probing. For high-output stoma >1200 mL/24 h, initiate fluid and electrolyte support and adjust diet, then reassess within 24 h.

Nurse-led psychological support

In both cohorts, anxiety and depression were assessed using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) at baseline and at 4 weeks as study outcomes. For the routine-care cohort, psychological care followed usual practice, which consisted of brief emotional reassurance during routine ward rounds and discharge education, provision of standard written instructions, and referral to mental-health services at the clinician's discretion when marked distress was identified; no structured, scheduled psychological sessions or tracking tools were routinely implemented. In contrast, the professional nursing pathway cohort received a standardized nurse-led psychological support module consisting of weekly 15 min sessions for 4 weeks that included cognitive restructuring focused on negative automatic thoughts, 3-5 min of breathing relaxation training, and a planned pleasant activity to be practiced daily; adherence was documented on a tracking card. Participants were referred to mental-health services when SAS/SDS scores met moderate or higher thresholds or when clinically indicated.

Lifestyle and diet

Advise loose clothing to avoid stoma irritation and restrict lifting >5 kg during the first 4 weeks. Progress physical activity from 2000-4000 steps/day in week 1 to 6000-8000 steps/day by week 4 as tolerated. Implement a low-residue, small-frequent-meals plan during weeks 1-2, then reintroduce gas-producing or high-fiber foods one at a time from week 3 while observing tolerance for 48 h after each new item. Ensure daily fluid intake of 1500-2000 mL unless contraindicated. Confirm the absence of nausea, bloating, or diarrhea during reintroduction and that bowel function remains stable.

Discharge guidance and follow-up

Provide written checklists for stoma change steps, red-flag signs, and points of contact. Schedule a week-1 tele-follow-up of about 10 min and week-2 and week-4 clinic or video reviews. Collect outcome scales and complication logs at scheduled contacts and reinforce techniques if leakage or skin issues recur. At the week-4 review, confirm independent technique and adherence to the pathway.

Outcome measures and assessment schedule

Assess outcomes at baseline (T0) and 1 month (T1). Measure self-care ability using the Self-Care Ability Assessment Scale (ESCA) with total and subscale scores. Evaluate psychological status using SAS and SDS standard scores. Assess quality of life using the City of Hope Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) with total and domain scores. Record early complications, including infection, stenosis, bleeding, peristomal dermatitis, and high output, and calculate a composite incidence. Evaluate nursing satisfaction at T1 with a four-level scale (very satisfied, basically satisfied, generally satisfied, dissatisfied) and report as n (%). Ensure that all scales are completed at both time points and that any adjudication of complications is documented.

Data management and quality assurance

Train nursing staff in the use of checklists and documentation. Audit approximately 10% of records for completeness and internal consistency. When feasible, separate outcome assessment from day-to-day caregivers to reduce measurement bias, and record protocol deviations with corrective actions. Conclude the pathway after completion of the 4-week follow-up, verification of outcomes, and closure of the quality-control log.

Statistical analysis

Analyze data with SPSS 25.0 (or equivalent). Summarize continuous variables as mean (SD) or median (IQR) after Shapiro-Wilk testing and choose independent-samples t tests or Mann-Whitney U tests; accordingly, summarize categorical variables as n (%) and compare using χ² or Fisher's exact tests. Report two-sided p-values with α = 0.05 and provide effect sizes with 95% confidence intervals (e.g., Cohen's d for continuous outcomes; risk ratio or risk difference for binary outcomes). For primary outcomes, perform ANCOVA or multivariable regression adjusted for prespecified baseline covariates (e.g., age, sex, key comorbidities). Control multiple comparisons where applicable (e.g., Benjamini-Hochberg FDR). Conduct sensitivity analysis for missing data handling and model specifications. State all software and package versions.

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.