Permanent stoma: a quality outcome in treatment of rectal cancer and its impact on length of stay

Abstract

Background This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility. Methods Rectal cancer patients who underwent elective surgery between January 2015 and December 2018 were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients. Results Of 2630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, advanced age, having open surgery, residence in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p < 0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p < 0.001). Conclusions Patients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Having permanent stoma was higher in patients living in South West Florida, patients with Medicaid insurance, and in the uninsured. Additionally, the payer type significantly affected the length of stay.

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage

“…Compared with the example of postoperative mortality, stoma-free survival is a complex endpoint affected by more factors than this study could capture. For example, defunctioning stomas will not be closed in patients with RC with progressive disease after surgery, 48,49 which could have modestly affected stoma-free survival in the current study. Moreover, socioeconomic status and cultural and geographical differences, such as acceptance of stomas and availability of stoma care, could have influenced decision-making.…”

Impact of patient choice and hospital competition on patient outcomes after rectal cancer surgery: A national population‐based study

“…This is important because the decision regarding which operation to perform considers several different factors including the location (height from anal verge) and staging of the tumor, comorbidities, likely functional outcome, response to neoadjuvant therapy, patient preference, and surgical experience/skill. The wider literature has demonstrated that disparities in stoma formation may also reflect socio‐demographic and geographic differences across populations 25 …”

“…The wider literature has demonstrated that disparities in stoma formation may also reflect socio-demographic and geographic differences across populations. 25 Persistent stoma at 18 months after anterior resection…”

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

“…Gastrointestinal diseases and their treatments commonly influence body image and self-esteem, which in turn can negatively affect sexual desire [160][161][162] . For example, patients with gastrointestinal diseases might have an ostomy or stoma as a result of disease and/or treatment [163][164][165][166] .…”

“…Approximately 80% of patients with colon cancer undergo surgery 283 and patients with rectal cancer are treated with multimodality therapy, including combinations of systemic therapy, radiotherapy and surgery, depending on disease extent and biomarkers 284 . The probability of a permanent ostomy for patients with CRC who undergo surgery ranges from 10% to 30% 164 , with up to 21% of patients with rectal cancer who undergo surgery requiring a permanent stoma 165 . In a survey study of 418 survivors of CRC of varied sexual orientations, 70% of patients reported issues with sexual desire 285 .…”