Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMC Health Serv Res. 2023 Aug 8;23(1):837. doi: 10.1186/s12913-023-09850-5.
Despite advance in care of people with an ostomy, related complications remain prevalent. The objective of this study was to examine short- and long-term healthcare resource utilization and associated costs after ostomy creation.
This observational study was based on retrospectively collected data from national and regional Swedish registries. The population consisted of people living in Sweden, who had an ostomy created. The earliest index date was 1 January 2006, and people were followed for ten years, until death, reversal of temporary ostomy, termination of purchases of ostomy products, or end of study, which was 31 December 2019. Each person with an ostomy was matched with two controls from the general population based on age, gender, and region.
In total, 40,988 persons were included: 19,645 with colostomy, 16,408 with ileostomy, and 4,935 with urostomy. The underlying diseases for colostomy and ileostomy creations were primarily bowel cancer, 50.0% and 55.8% respectively, and additionally inflammatory bowel disease for 20.6% of ileostomies. The underlying cause for urostomy creation was mainly bladder cancer (85.0%). In the first year after ostomy creation (excl. index admission), the total mean healthcare cost was 329,200 SEK per person with colostomy, 330,800 SEK for ileostomy, and 254,100 SEK for urostomy (100 SEK was equivalent to 9.58 EUR). Although the annual mean healthcare cost decreased over time, it remained significantly elevated compared to controls, even after 10 years, with hospitalization being the main cost driver. The artificial opening was responsible for 19.3-22.8% of 30-day readmissions after ostomy creation and for 19.7-21.4% of hospitalizations during the entire study period. For the ileostomy group, dehydration was responsible for 13.0% of 30-day readmissions and 4.5% of hospitalization during the study period.
This study reported a high disease burden for persons with an ostomy. This had a substantial impact on the healthcare cost for at least ten years after ostomy creation. Working ability seemed to be negatively impacted, indicated by increased cost of sickness absence and early retirement. This calls for improved management and support of ostomy care for the benefit of the affected persons and for the cost of society.
尽管人们对造口术患者的护理水平有所提高，但相关并发症仍然普遍存在。本研究的目的是探讨造口术后短期和长期的医疗资源利用情况及相关费用。
本观察性研究基于瑞典国家和地区登记处的回顾性数据。该人群包括居住在瑞典的造口患者。最早的索引日期为 2006 年 1 月 1 日，随访时间为 10 年，直至死亡、临时造口术逆转、停止购买造口产品或研究结束（2019 年 12 月 31 日）。每位造口患者都根据年龄、性别和地区与两名普通人群对照相匹配。
共纳入 40988 人：结肠造口术 19645 例，回肠造口术 16408 例，尿路造口术 4935 例。结肠造口术和回肠造口术的主要基础疾病分别为结直肠癌（50.0%和 55.8%），此外，20.6%的回肠造口术为炎症性肠病。尿路造口术的主要病因是膀胱癌（85.0%）。在造口术后的第一年（不包括索引入院），结肠造口术患者的人均医疗保健总费用为 329200 瑞典克朗，回肠造口术为 330800 瑞典克朗，尿路造口术为 254100 瑞典克朗（100 瑞典克朗约合 9.58 欧元）。尽管医疗保健费用随着时间的推移呈下降趋势，但与对照组相比，即使在 10 年后仍显著偏高，住院治疗是主要的费用驱动因素。人造开口是造口术后 30 天内再入院和整个研究期间住院的主要原因，占比分别为 19.3-22.8%和 19.7-21.4%。对于回肠造口术患者，脱水导致 30 天内再入院的占比为 13.0%，研究期间住院的占比为 4.5%。
本研究报告了造口患者的疾病负担很高。这对造口术后至少 10 年的医疗保健费用产生了重大影响。工作能力似乎受到了负面影响，表现为病假和提前退休导致的成本增加。这需要改善造口护理管理和支持，以造福于受影响者，并减轻社会成本。
