Cost analysis in a randomized trial of early closure of a temporary ileostomy after rectal resection for cancer (EASY trial)

Park, Jennifer; Angenete, Eva; Bock, David; Correa-Marinez, Adiela; Danielsen, Anne Kjærgaard; Gehrman, Jacob; Haglind, Eva; Jansen, Jens Erik; Skullman, S.; Wedin, Anette; Rosenberg, Jacob

doi:10.1007/s00464-019-06732-y

Cited by 28 publications

(27 citation statements)

References 24 publications

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“…Within the cohort, we report a high rate of loop ileostomy-related SBO with various causes both before and after closure, which together with other negative ileostomy-related outcomes, such as poorer functional outcomes and costs, raises concern about the routine use of loop ileostomy [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for small bowel obstruction after open rectal cancer resection

et al. 2021

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Background Small bowel obstruction (SBO) is observed in around 10% of patients with prior open abdominal surgery. Rectal resection causes the highest readmission rates. The aim of this study was to investigate risk factors for readmission for SBO and causes for SBO in patients who needed surgery following rectal cancer surgery. Methods A population-based registry with prospectively gathered data on 752 consecutive patients with rectal cancer who underwent open pelvic surgery between January 1996 and January 2017 was used. Univariable and multivariable regression analysis was performed, and the risk of SBO was assessed. Results In total, 84 patients (11%) developed SBO after a median follow-up time of 48 months. Of these patients, 57% developed SBO during the 1st year after rectal cancer surgery. Surgery for SBO was performed in 32 patients (4.3%), and the cause of SBO was stoma-related in one-fourth of these patients. In the univariable analysis previous RT and re-laparotomy were found as risk factors for readmission for SBO. Re-laparotomy was an independent risk factor for readmission for SBO (OR 2.824, CI 1.129–7.065, P = 0.026) in the multivariable analysis, but not for surgery for SBO. Rectal resection without anastomoses, splenic flexors mobilization, intraoperative bleeding, operative time were not found as risk factors for SBO. Conclusions One-tenth of rectal cancer patients who had open surgery developed SBO, most commonly within the 1st postoperative year. The risk of SBO is greatest in patients with complications after rectal cancer resection that result in a re-laparotomy.

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Section: Discussionmentioning

confidence: 99%

Risk factors for small bowel obstruction after open rectal cancer resection

et al. 2021

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“…From the cost perspective, Park and colleagues found that there was a significant reduction in the mean cost of early stoma closure of USD 4060 compared to late closure 43 . The cost savings stemmed mostly from there being fewer reoperations, readmissions and endoscopic examinations.…”

Section: Discussionmentioning

confidence: 99%

The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis

Levitt

Platell

2020

ANZ Journal of Surgery

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Background Recent evidence supports the safety of early reversal of a temporary stoma, within 14 days of construction. The aim of this systematic review and meta‐analysis was to evaluate the post‐operative morbidity and overall feasibility of early stoma reversal. Methods Medline and Cochrane databases were searched for studies up to June 2019 that investigated the outcomes of early stoma reversal (EC, defined as closure ≤14 days from the index operation) versus late stoma reversal (LC, ≥8 weeks from the index operation). Meta‐analysis was performed on the respective rates of post‐operative morbidity, anastomotic leak, wound infection, bleeding, sepsis, small bowel obstruction and ileus. Results Nine studies were included (667 patients analysed). Meta‐analysis showed no significant difference in the post‐operative morbidity rate, anastomotic leak rate, rates of small bowel obstruction, bleeding and ileus between EC and LC. However, the wound infection rate was significantly higher after EC than LC; relative difference 0.10 (95% confidence interval 0.00–0.19, P = 0.047). The stoma‐related complication rate was significantly higher after LC than EC; relative difference −0.28 (95% confidence interval ‐0.45 to −0.11, P = 0.001). Conclusion The concept of early stoma reversal is appealing, and this meta‐analysis confirms the safety of early stoma closure with an associated reduction in stoma‐related complications despite higher wound infection rates. However, the results need to be interpreted with caution due to the heterogeneity of the studies included, especially in respect of the definition of complications that were used. Further well‐designed prospective studies are required prior to confident adoption of early stoma closure into clinical practice.

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“…[3][4][5]8,[16][17][18][19][20][21][22] In addition, prolonged time to closure (more than 6 months) of temporary stomas was found to increase the risk of complications and the length of hospital stay, subsequently worsens the patients' quality of life and raising hospital costs. [6][7][8] Understanding risk factors for the development of these complications would aid in targeting them for preventive measures thus, improve patients' outcomes. As the time to stoma closure is considered an important predictor for complications, determining the factors which prolong the time to closure is important.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] In addition, prolonged time to closure (more than 6 months) of temporary stomas was found to increase the risk of complications and the length of hospital stay, subsequently worsens the patients' quality of life and raising hospital costs. [6][7][8] Given the implications of prolonged time to stoma closure, identifying risk factors which prolong the time to closure would aid in targeting them for preventive measures. Therefore, this study was conducted to determine risk factors that affect the time to stoma closure and identify predictors of stoma-closure complications among ostomy patients at our institute.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting temporary stoma outcomes at a major Saudi University Hospital

et al. 2020

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Background: Temporary stoma formation for fecal diversion is commonly performed in surgery. The rate of stoma-related complications is high, and the risk increases in patients with prolonged time to closure. Thus, identifying factors that influence the time to stoma closure and the rate of its complications would aid in implementing preventive measures. We aimed to determine predictors affecting the time to stoma closure and to identify risk factors for developing complications following stoma reversal.Methods: A retrospective review including all adult patients who underwent stoma closure from 2012-2018 at our institution was conducted. Multivariate regression analysis was used to determine risk factors affecting time to stoma closure and developing complications after reversal surgery.Results: A total of 63 patients were included. Of those, 50.8% were diagnosed with malignancy. The median time to stoma closure was 222.5 days (interquartile range i.e. IQR 12-2228).Having an American society of anesthesiologists (ASA) class IV was the only significant predictor of prolonged time to closure. For cancer patients, developing complications following stoma formation surgery, and receiving adjuvant therapy significantly increased the time to stoma reversal. In contrast, cancer patients who underwent multi-organ resection had shorter time to closure. The rate of complications following stoma reversal was 30.2%. Having a colostomy and requiring readmission after stoma formation surgery increased the risk of developing complications related to stoma reversal.Conclusions: Multiple factors can impact the time to stoma closure and increase the risk of developing complication related to stoma closure. Awareness about these factors and development of preventive strategies is recommended.

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Cost analysis in a randomized trial of early closure of a temporary ileostomy after rectal resection for cancer (EASY trial)

Cited by 28 publications

References 24 publications

Risk factors for small bowel obstruction after open rectal cancer resection

Risk factors for small bowel obstruction after open rectal cancer resection

The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis

Factors affecting temporary stoma outcomes at a major Saudi University Hospital

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