{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:06:26Z","timestamp":1790251586957,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Temporary loop ileostomy formation is a routine procedure performed to protect distal colorectal anastomosis. Traditionally, the ideal timing of ileostomy reversal is believed to fall between 3 and 6 months. It has been suggested that delayed reversal increases the risk of complications. Our study looks to demonstrate the relationship between delayed reversal and its associated risks in a real\u2010world setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This is a retrospective cohort study conducted at Monash Health, analysing patients who underwent loop ileostomy reversal from May 2016 to December 2023. Main outcome measures include incidence of post\u2010reversal complications, including colitis,\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Clostridium difficile<\/jats:italic>\n                      <\/jats:styled-content>\n                      infection, anastomotic leak, ileus, wound infection and acute kidney injury. Secondary outcome is to investigate the impact of COVID\u201019 on ileostomy reversal timing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 223 patients were included. The primary indications for initial surgery included cancer (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009134), inflammatory bowel disease (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200919) and diverticular disease (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929). The median time between initial surgery and ileostomy reversal was 341\u2009days (IQR\u2009=\u2009211\u2013530). Post\u2010reversal complications occurred in 65 patients (29.1%). Patients reversed after the pandemic experienced a delay between surgeries (median: 411, IQR\u2009=\u2009276\u2013660) compared with those prior (median: 294, IQR\u2009=\u2009196\u2013408,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). A statistically significant association was seen between delayed reversal and post\u2010operative complications (OR 1.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020, ROC AUC\u2009=\u20090.588). Ileostomy reversal occurring beyond 134\u2009days (based on the Youden's Index with 90% sensitivity\u2010based cutoff) is associated with increased risk of complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Delayed loop ileostomy reversal is associated with post\u2010operative complications specifically colitis and\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>C. difficile<\/jats:italic>\n                      <\/jats:styled-content>\n                      colitis.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70838","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T02:10:47Z","timestamp":1782958247000},"page":"2658-2664","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed Loop Ileostomy Reversal Increases the Risk of Colitis and\n                    <i>Clostridium difficile<\/i>\n                    Infection"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4919-0917","authenticated-orcid":false,"given":"Yan S.","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0302-5337","authenticated-orcid":false,"given":"S.","family":"Fujino","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus E. H.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann W. Z.","family":"Leh","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asiri M. K.","family":"Arachchi","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Narasimhan","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas S.","family":"Suhardja","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanumant S.","family":"Chouhan","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pathirajage C. K.","family":"Saranasuriya","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James T.","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thang C.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M. K.","family":"Teoh","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeng K.","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Surgery (School of Clinical Sciences at Monash Health) Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-022-02629-6"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.25270\/owm.2018.12.3035"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-74372-x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3448-7"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.821509"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16095"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001829"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.18311"},{"key":"e_1_2_9_10_1","first-page":"1","article-title":"KDIGO Clinical Practice Guideline for Acute Kidney Injury","volume":"2","author":"Kidney International Supplements","year":"2012","journal-title":"Official Journal of the International Society of Nephrology"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.17411"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15858"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13873"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-021-01749-9"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit280"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2023.155639"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.55729\/2000-9666.1123"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2017.1339003"},{"key":"e_1_2_9_19_1","first-page":"1274","article-title":"Diverting Colostomy Induces Mucosal and Muscular Atrophy in Rat Distal Colon","volume":"35","author":"HC P. K.\u2010N.","year":"1994","journal-title":"Gut"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1017\/gmb.2024.1"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000237"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-023-02807-0"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-023-07065-x"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15463"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13020626"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2024.2423037"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.38.4.568"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15092211"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02049697"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-021-01087-5"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbrep.2020.100892"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70838","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.70838","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70838","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:16:44Z","timestamp":1790248604000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":30,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/ans.70838"],"URL":"https:\/\/doi.org\/10.1111\/ans.70838","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"assertion":[{"value":"2025-09-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}