Development and clinical validation of a predictive scoring model for local intestinal stoma complications

Objective: To develop and clinically validate a predictive scoring model for early risk stratification of local intestinal stoma complications. Materials and Methods: A retrospective multicenter analytical study included 156 patients with intestinal stomas formed during abdominal surgery from 2023 to 2026. Clinical, laboratory, intraoperative and early postoperative factors were analyzed. Local complications were classified as stomal, peristomal or combined. Odds ratios were calculated for potential predictors. Two scoring systems were developed: an integral model for all local complications and a specialized model for stomal complications related mainly to perfusion and technical factors. Diagnostic performance was assessed using threshold-based stratification. Results: Local complications occurred in 61 patients (39.1%): stomal complications in 11 (7.1%), peristomal complications in 38 (24.4%) and combined complications in 12 (7.7%). The strongest predictors were intraoperative impaired blood supply to the stoma edge, purulent or fecal peritonitis, immunosuppression or immunodeficiency, absence of bowel fixation to the aponeurosis, bowel tension, emergency surgery, diabetes mellitus and hypoalbuminemia. The integral 16-factor model showed optimal performance at a threshold of 9 points, with sensitivity of 95.1% and specificity of 85.3%. Complication rates increased from 3.6% in the low-risk group to 65.0% in the moderate-risk group and 100% in the high-risk group. The specialized stomal complication score identified a threshold of 7 points, at which stomal complications reached 52.8%. Conclusion: Local intestinal stoma complications are determined by the cumulative effect of systemic, inflammatory and intraoperative technical factors. The proposed scoring models provide clinically applicable early risk stratification and may support individualized preventive and surgical decision-making.

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