Cost Analysis of Early versus Delayed Loop Ileostomy Closure: A Case-Matched Study

Abstract

Background/Aims: The optimal timing for the closure of loop ileostomies remains controversial. The aim of the current study was to investigate whether early ileostomy closure (EC) (<2 weeks post-formation) results in significant healthcare savings as against late closure (LC). Methods: Patients with available cost data that underwent EC between January 2008 and December 2012 were compared against matched patients undergoing LC during the same period. Direct hospital costs for the two groups were compared. Results: There were 42 EC patients and 61 LC patients. EC patients had significantly less ileostomy-related complications (p < 0.001) and hospital readmissions (p < 0.001). Operative time (p < 0.001) and operative cost (p = 0.002) were also both significantly less in the EC group. Community nursing costs favoured the LC group (p = 0.047). The EC group had an increased post-closure wound infection rate (p = 0.02). The mean total direct cost per patient was NZD 13,724 (SD NZD 3,736) for EC and NZD 16,728 (SD NZD 8,028) for LC. Representing an average costs saving of NZD 3,004 per patient favouring EC (p = 0.012). Conclusion: Although EC increases the post-closure wound infection rate, EC reduces ileostomy complications, hospital readmissions and operative costs resulting in significant healthcare savings. In order to improve patient outcomes and make EC even more cost effective, efforts should be taken to reduce wound infections.

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

“…Early closure of a temporary stoma has been associated with significantly fewer postoperative complications up to 12 months after rectal resection in a randomized controlled trial [13]. Although the routine use of a temporary stoma in patients operated with low anterior resection increases the hospital costs of surgical treatment for rectal cancer [12], early closure of such may be a cost-effective alternative [14].…”

Meta-analysis of early versus late closure of a temporary ileostomy after proctectomy

“…Third, this meta-analysis did not address cost efficacy. The cost savings associated with early versus late ileostomy reversal was reported in a case-matched study involving 103 patients [40]. Direct hospital costs were compared and it was found that early closure reduced healthcare costs by approximately 25%, despite higher wound infection rates [40].…”

“…The cost savings associated with early versus late ileostomy reversal was reported in a case-matched study involving 103 patients [40]. Direct hospital costs were compared and it was found that early closure reduced healthcare costs by approximately 25%, despite higher wound infection rates [40]. The overall reduced hospital stay combined with savings in stoma care may make this a cost-effective approach, but further study is needed to clarify this.…”

LOOP ILEOSTOMY CLOSURE (review)

“…Однако, как указали авторы, выгоды от столь быстрой выписки могут нивелироваться увеличением стоимости за счет увеличения частоты повторных госпитализаций, достигающей 10,7%. Закрытие илеостомы менее, чем через 2 недели после ее формирования, также позволяет сокращать расходы (13724 против 16728 €, р=0,01), однако уровень осложнений достоверно увеличивается [11,24]. К сожалению, в настоящее время нельзя экстрапо-лировать результаты, полученные американским и европейским сообществом хирургов, на территорию Российской Федерации, так как различие экономических систем, производства, школ хирургов, социальных условий проживания пациентов -безусловно, накладывают свой отпечаток на качество и уровень хирургии в нашей стране.…”