Department of Surgical and Perioperative Sciences, Umeå University, SE-901 88, Umeå, Sweden.
Int J Colorectal Dis. 2019 Jun;34(6):993-1000. doi: 10.1007/s00384-019-03258-6. Epub 2019 Feb 12.
To see if road distance to hospital influences stoma reversal rate, time from index operation to stoma reversal, and occurrence of permanent stoma.
Data from all diagnosed cases of rectal cancer from three counties in northern Sweden were extracted from the Swedish Rectal Cancer Registry. The three counties are sparsely populated, with a population density roughly one fifth the average density in Sweden. Distances to nearest, operating, and largest hospital were obtained using Google Maps™. Matched data on socioeconomic variables were retrieved from Statistics Sweden.
In univariate logistic regression analysis, patients living closer to the operating hospital had a higher likelihood of non-reversal than those living farther away (OR 0.3; 95% CI 0.12-0.76). However, no difference was seen in the multivariate analysis. Of the 717 cases included, 54% received a permanent stoma and 38% a defunctioning stoma at index surgery. The reversal rate of a defunctioning stoma was 83%. At follow-up, 61% still had a stoma, 89% of these were permanent, and 11% non-reversed defunctioning stomas. Median time to stoma reversal was 287 days (82-1557 days). Of all 227 stoma reversals, 77% were done more than 6 months after index surgery.
Longer distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. Only 23% had their defunctioning stoma reversed within 6 months after index surgery. Future studies aiming to determine reversal rate need to extend their follow-up time in order to receive accurate results.
观察距离医院的路程是否影响造口还纳率、从初始手术到造口还纳的时间以及永久性造口的发生。
从瑞典直肠肿瘤登记处提取了瑞典北部三个县所有确诊直肠癌病例的数据。这三个县人口稀少，人口密度大约是瑞典平均密度的五分之一。使用 Google Maps™ 获取到最近、手术和最大医院的距离。从瑞典统计局检索到匹配的社会经济变量数据。
在单变量逻辑回归分析中，与居住在远离手术医院的患者相比，居住在手术医院附近的患者更有可能不进行还纳（OR 0.3；95%CI 0.12-0.76）。然而，在多变量分析中没有差异。在纳入的 717 例患者中，54%的患者在初始手术时接受了永久性造口，38%的患者接受了预防性造口。预防性造口的还纳率为 83%。随访时，61%的患者仍有造口，其中 89%为永久性造口，11%为未还纳的预防性造口。造口还纳的中位时间为 287 天（82-1557 天）。所有 227 例造口还纳中，77%是在初始手术后 6 个月以上进行的。
距离医院较远不是预防性造口不还纳的危险因素。只有 23%的患者在初始手术后 6 个月内进行了预防性造口还纳。旨在确定还纳率的未来研究需要延长随访时间，以获得准确的结果。
