Propensity Score Analysis of the Utility of Supervised Perioperative Abdominal Wall Exercises for the Prevention of Parastomal Hernia.

Retrospective studies have suggested that performing perioperative abdominal wall exercises may decrease the incidence of parastomal hernias. Objectives: This study seeks to assess the usefulness of supervised preoperative and postoperative abdominal wall exercises in the prevention of parastomal hernia. Methods: An observational study of patients who underwent a stoma, temporary or permanent, between January 2019 and December 2020, was performed. Minimum follow-up was 12 months. During the first 12 months of recruitment, patients were enrolled on a consecutive basis and assigned to the control group, and the remaining patients were assigned to the intervention group. A propensity score matching was performed to obtain totally comparable groups. A set of exercises was designed by the Rehabilitation Department, and their performance was supervised by physiotherapists and stoma therapists. The diagnosis of parastomal hernia was made by physical examination and computed axial tomography. Descriptive statistics of the study group were performed. Subsequently, prediction models for the occurrence of parastomal hernia were created based on binary logistic regression and classification trees. Results: After propensity matching and inclusion criteria, 64 patients were included (colostomy: n = 39, ileostomy: n = 25). Independent prognostic variables for parastomal hernias in colostomy were age (p = 0.044) and perioperative exercises (p = 0.003). The binary logistic regression model based on these variables gave an AUC of 97.6. The classification tree model included only perioperative exercises with an AUC of 92.5%. In the case of ileostomy, perioperative exercises were the only independent prognostic variable identified. The classification-tree-based model reported an AUC of 84%. Conclusions: The performance of supervised abdominal wall training and strengthening exercises may be useful in the prevention of parastomal hernias.