The Impact of COVID-19 on Timely Reversal of Defunctioning Loop Ileostomy Following Low Anterior Resection: A Cohort Study

Abstract

Aim: The COVID-19 pandemic disrupted healthcare systems, causing delays in elective surgeries and potential adverse patient outcomes. A covering loop ileostomy, commonly created during low anterior resection, is ideally reversed within 2-4 months. Delays beyond 6 months are linked to increased patient distress and complication risks. This study assessed the pandemic's impact on ileostomy reversal timing by comparing pre-COVID-19 and COVID-19 era timelines. Method(s): We analysed a prospectively maintained colorectal operative database, identifying patients with covering loop ileostomies after anterior resection in 2017-2018 and 2020-2021. Stoma formation and reversal rates were compared between these cohorts using Chi-square and independent Student t-tests, with significance set at p < 0.05. Result(s): Seventy-eight patients had low anterior resections with ileostomies (45 pre-COVID and 33 during COVID). Of these, 32 patients in 2017-2018 and 19 in 2020-2021 were analysed. Groups were matched for age (65.02 vs. 64.99 years, p = 0.09), gender ratio, and adjuvant chemotherapy rates (5 vs. 2 patients, p = 0.08). All suitable pre-COVID patients underwent reversal, but 7 suitable COVID-era patients remained unreversed by study end. Mean time to reversal was 5.1 months pre-COVID vs. 10.7 months during COVID (p = 0.0001). Conclusion(s): The COVID-19 pandemic significantly delayed timely reversal of loop ileostomies. Patients during the pandemic waited twice as long for stoma reversal compared to the pre-COVID era.