Barnard Jon, Milne Tony, Teo Keith, Weston Maree, Israel Lincoln, Peng Sze-Lin
Coloreectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
General Surgery, Nelson Hospital, Nelson, New Zealand.
ANZ J Surg. 2023 Mar;93(3):636-642. doi: 10.1111/ans.18092. Epub 2022 Oct 6.
Defunctioning loop ileostomies (DLIs) are a frequent adjunct to rectal cancer surgery. Delayed closure of DLIs is common and associated with increased morbidity. The reasons for delayed DLI closure are often unknown. The economic burden of delayed DLI closure is not quantified. The present study aimed to determine the reasons for, and economic burden of, delayed DLI closure.
Clinical and economic data were audited from a prospective database of patients in two Australasian colorectal cancer centres. Patients treated at each unit with low/ultra-low anterior resection for rectal cancer with formation of DLI between January 2014 and December 2019 were included. Post-operative complication rate, stoma-related complication rate and costs of hospital admissions and stoma care were recorded and analysed. Multivariate linear regression analysis was used to investigate risk factors for delay to closure.
146 patients underwent low/ultra-low anterior resection with DLI; 135 patients (92.5%) underwent reversal. The median duration to reversal was 7 months (IQR 4.5-9.5). Sixty-six percent of patients underwent reversal >6 months after their index surgery. Neoadjuvant and adjuvant chemotherapy were associated with delayed reversal (P < 0.001). Non-English speakers waited longer for DLI closure (P = 0.028). The costs of outpatient stoma care (P < 0.001), post-operative care (P = 0.004), and total cost of treatment (P = 0.014) were significantly higher in the delayed closure group, with a total cost of treatment difference of $3854 NZD per patient.
Causes of delay include systemic factors and demographic factors that can be addressed directly, addressing such causes may alleviate a significant economic burden.
去功能化回肠造口术（DLIs）是直肠癌手术中常用的辅助手段。DLIs延迟关闭很常见，且与发病率增加相关。DLIs延迟关闭的原因通常不明。DLIs延迟关闭的经济负担尚未量化。本研究旨在确定DLIs延迟关闭的原因及经济负担。
从两个澳大利亚结直肠癌中心的前瞻性患者数据库中审核临床和经济数据。纳入2014年1月至2019年12月期间在各单位接受低位/超低位前切除术治疗直肠癌并形成DLIs的患者。记录并分析术后并发症发生率、造口相关并发症发生率以及住院和造口护理费用。采用多变量线性回归分析来研究延迟关闭的危险因素。
146例患者接受了低位/超低位前切除术并进行了DLIs；135例患者（92.5%）进行了回纳。回纳的中位时间为7个月（四分位间距4.5 - 9.5）。66%的患者在初次手术后>6个月进行了回纳。新辅助和辅助化疗与延迟回纳相关（P < 0.001）。非英语使用者等待DLIs关闭的时间更长（P = 0.028）。延迟关闭组的门诊造口护理费用（P < 0.001）、术后护理费用（P = 0.004）和总治疗费用（P = 0.014）显著更高，每位患者的总治疗费用差异为3854新西兰元。
延迟的原因包括可直接解决的系统因素和人口统计学因素，解决这些原因可能减轻重大的经济负担。
