Morbidity related to defunctioning loop ileostomy in low anterior resection

Åkesson, Oscar; Syk, Ingvar; Lindmark, Gunilla; Buchwald, Pamela

doi:10.1007/s00384-012-1490-y

Cited by 83 publications

(80 citation statements)

References 23 publications

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“…Available literature shows the formation of a defunctioning stoma to carry morbidity in the early postoperative period [32, 33] and to extend postoperative hospital stay [34], mirroring our findings; however, the presence of a defunctioning stoma being associated with delay to adjuvant therapy has not been previously documented. The use of a defunctioning stoma is commonly associated with patients who have undergone preoperative chemoradiotherapy, rectal resections, and major or difficult resections, factors which may represent the cause of delay as opposed to the presence of a stoma.…”

Section: Discussionsupporting

confidence: 86%

The Aetiology of Delay to Commencement of Adjuvant Chemotherapy following Colorectal Resection

Simpson

Smith

Sutton

et al. 2014

International Journal of Surgical Oncology

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Purpose. Timely administration of adjuvant chemotherapy following colorectal resection is associated with improved outcome. We aim to assess the factors which are associated with delay to adjuvant chemotherapy in patients who underwent colorectal resection as part of an enhanced recovery protocol. Method. A univariate and multivariate analysis of patient data collected as part of a prospectively maintained database of colorectal cancer patients between 2007 and 2012. Results. 166 patients underwent colorectal resection followed by adjuvant chemotherapy. Median postoperative hospital stay was 6 days, and time to commencement of adjuvant chemotherapy was 50 days. Longer inpatient stay correlated with increased time to adjuvant chemotherapy (P = 0.05). Factors found to be independently associated with duration of hospital stay and time to commencement of adjuvant chemotherapy included stoma formation (P = 0.032), anastaomotic leak (P = 0.027), and preoperative albumin (P = 0.027). The use of laparoscopic surgery was associated with shorter time to adjuvant chemotherapy but did not reach significance (P = 0.143). Conclusion. A number of independent variables associated with delay to adjuvant therapy previously not described have been identified. Further work may be required to elucidate the effect that these variables have on long-term outcome.

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Section: Discussionsupporting

confidence: 86%

The Aetiology of Delay to Commencement of Adjuvant Chemotherapy following Colorectal Resection

Simpson

Smith

Sutton

et al. 2014

International Journal of Surgical Oncology

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“…Patients receiving neoadjuvant therapy generally have reversal of their ileostomies postponed until adjuvant chemotherapy is completed; this would account for the difference existing between groups. Several studies have suggested that ileostomy closure before adjuvant chemotherapy may be beneficial in improving chemotherapy delivery; however, concerns remain regarding the impact post ileostomy closure complications may have on the timely administration of adjuvant chemotherapy [5,13,27,33]. Such concerns appear valid, given the increased wound infection rates associated with early closure.…”

Section: Discussionmentioning

confidence: 92%

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

et al. 2015

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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.

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“…Obviously, AL rates are only calculated for patients in whom an anastomosis has been created. Therefore hospitals with lower rates of patients with anastomoses could automatically have better scores without providing better quality of care, as the stoma itself may cause morbidity, lead to increased readmissions51 52 and may be associated with morbidity at the time of surgical removal of the stoma 53. In reality, there is probably an optimum percentage of defunctioning stomas and end colostomies to be constructed, and AL rates should always be seen in the light of these percentages.…”

Section: Discussionmentioning

confidence: 99%

Anastomotic leakage as an outcome measure for quality of colorectal cancer surgery

et al. 2013

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Morbidity related to defunctioning loop ileostomy in low anterior resection

Cited by 83 publications

References 23 publications

The Aetiology of Delay to Commencement of Adjuvant Chemotherapy following Colorectal Resection

The Aetiology of Delay to Commencement of Adjuvant Chemotherapy following Colorectal Resection

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

Anastomotic leakage as an outcome measure for quality of colorectal cancer surgery

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