Basil I. Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, JT 664, 1530-3rd Avenue S, Birmingham, AL 35294-0012, USA.
Surg Endosc. 2011 Jul;25(7):2203-9. doi: 10.1007/s00464-010-1523-y. Epub 2011 Feb 4.
Although stent placement is increasingly performed, colostomy still is considered the gold standard for emergent relief of malignant colonic obstruction (MCO). This study aimed to compare hospital costs and clinical outcomes between patients undergoing colostomy and those undergoing stenting for the management of MCO.
A retrospective claims analysis of the Medicare Provider Analysis and Review (MedPAR) data set was conducted to identify inpatient hospitalizations for colostomy or stent placement for the treatment of colon cancer (2007-2008). The outcomes evaluated using MedPAR compared the total length of hospital stay (LOS) and the costs associated with both techniques. Because MedPAR is a claims data set that does not provide outcomes at a patient level, a single-institution retrospective case-control study was conducted in which each stent placement patient was matched with two colostomy patients during the same period. Outcome measures (institutional data) were used to compare rates of treatment success, postprocedure LOS, and reinterventions between the two cohorts.
The MedPAR data evaluated 778 stent placements and 5,868 colostomy hospitalizations. There were no differences in gender, age distribution, or comorbidity between the two groups. Compared with colostomy, the median LOS (8 vs. 12 days; p<0.0001) and the median cost ($15,071 vs. $24,695; p<0.001) per claim were significantly less for stent placement. Stent placement was more commonly performed at urban versus rural hospitals (84% vs. 16%; p<0.0001), teaching versus nonteaching hospitals (56% vs. 44%; p=0.0058) and larger versus smaller institutions (mean bed capacity, 331 vs. 227; p<0.0001). The institution data included 12 patients who underwent stent placement and 24 who underwent colostomy. Although both methods were technically successful, the median postprocedure LOS (2.17 vs. 10.58 days; p=0.0004) and the rate of readmissions for complications (0% vs. 25%; p=0.01) were significantly lower for stent placement.
Although the technical and clinical outcomes for colostomy and stent placement appear comparable, stent placement is less costly and associated with shorter LOS and fewer complications. Dissemination of stent placement beyond large teaching hospitals located in urban areas as a treatment for MCO is important given its implications for patient care and resource use.
尽管支架置入术的应用日益增多，但结肠造口术仍被认为是治疗恶性结肠梗阻（MCO）的金标准。本研究旨在比较支架置入术和结肠造口术治疗 MCO 的住院费用和临床结局。
对 Medicare Provider Analysis and Review（MedPAR）数据集进行回顾性索赔分析，以确定 2007-2008 年因结肠癌而行结肠造口术或支架置入术的住院患者。MedPAR 中评估的结局比较了两种技术的总住院时间（LOS）和相关费用。由于 MedPAR 是一个索赔数据集，并未提供患者层面的结局，因此进行了一项单机构回顾性病例对照研究，在该研究中，每个支架置入术患者与同期的两名结肠造口术患者相匹配。使用机构数据比较两组的治疗成功率、术后 LOS 和再干预率。
MedPAR 数据评估了 778 例支架置入术和 5868 例结肠造口术住院患者。两组间的性别、年龄分布或合并症无差异。与结肠造口术相比，支架置入术的中位 LOS（8 天与 12 天；p<0.0001）和中位费用（15071 美元与 24695 美元；p<0.001）均显著降低。支架置入术更多地在城市而非农村医院（84%与 16%；p<0.0001）、教学医院而非非教学医院（56%与 44%；p=0.0058）以及更大规模的机构（平均床位数为 331 与 227；p<0.0001）进行。机构数据包括 12 例行支架置入术的患者和 24 例行结肠造口术的患者。尽管两种方法在技术上均成功，但支架置入术的术后 LOS 中位数（2.17 天与 10.58 天；p=0.0004）和并发症再入院率（0%与 25%；p=0.01）显著更低。
尽管结肠造口术和支架置入术的技术和临床结局似乎相当，但支架置入术的费用更低，LOS 更短，并发症更少。鉴于支架置入术对患者护理和资源利用的影响，将其在大城市的大型教学医院以外的地区推广用于治疗 MCO 非常重要。
