H Floodeen1, O Hallböök2, L A Hagberg3, P Matthiessen4. 1. Department of Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Fakultetsgatan 1, 70182 Örebro, Sweden. Electronic address: hfloodeen@gmail.com. 2. Department of Surgery, Linköping University Hospital, 58183 Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden. Electronic address: olof.hallbook@regionostergotland.se. 3. Center for Health Care Science, Örebro County Council, 70182 Örebro, Sweden. Electronic address: lars.hagberg@oru.se. 4. Department of Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Fakultetsgatan 1, 70182 Örebro, Sweden. Electronic address: peter.matthiessen@regionorebrolan.se.
Abstract
BACKGROUND:Defunctioning stoma in low anterior resection (LAR) for rectal cancer can prevent major complications, but overall cost-effectiveness for the healthcare provider is unknown. This study compared inpatient healthcare resources and costs within 5 years of LAR between two randomized groups of patients undergoing LAR with and without defunctioning stoma. METHOD: Five-year follow-up of a randomized, multicenter trial on LAR (NCT 00636948) with (stoma; n = 116) or without (no stoma; n = 118) defunctioning stoma comparing inpatient healthcare resources and costs. Unplanned stoma formation, days with stoma, length of hospital stay, reoperations, and total associated inpatient costs were analyzed. RESULTS:Average costs were € 21.663 per patient with defunctioning stoma and € 15.922 per patient without defunctioning stoma within 5 years of LAR, resulting in an average cost-saving of € 5.741. There was no difference between groups regarding the total number of days with any stoma (stoma = 33398 vs. no stoma = 34 068). The total number of unplanned reoperations were 70 (no stoma) and 32 (stoma); p < 0.001. In the group randomized to no stoma at LAR, 30.5% (36/118) required an unplanned stoma later. CONCLUSION: Randomization to defunctioning stoma in LAR was more expensive than no stoma, despite the cost-savings associated with a reduced frequency of anastomotic leakage. Both groups required the same total number of days with a stoma within five years of LAR.
RCT Entities:
BACKGROUND: Defunctioning stoma in low anterior resection (LAR) for rectal cancer can prevent major complications, but overall cost-effectiveness for the healthcare provider is unknown. This study compared inpatient healthcare resources and costs within 5 years of LAR between two randomized groups of patients undergoing LAR with and without defunctioning stoma. METHOD: Five-year follow-up of a randomized, multicenter trial on LAR (NCT 00636948) with (stoma; n = 116) or without (no stoma; n = 118) defunctioning stoma comparing inpatient healthcare resources and costs. Unplanned stoma formation, days with stoma, length of hospital stay, reoperations, and total associated inpatient costs were analyzed. RESULTS: Average costs were € 21.663 per patient with defunctioning stoma and € 15.922 per patient without defunctioning stoma within 5 years of LAR, resulting in an average cost-saving of € 5.741. There was no difference between groups regarding the total number of days with any stoma (stoma = 33 398 vs. no stoma = 34 068). The total number of unplanned reoperations were 70 (no stoma) and 32 (stoma); p < 0.001. In the group randomized to no stoma at LAR, 30.5% (36/118) required an unplanned stoma later. CONCLUSION: Randomization to defunctioning stoma in LAR was more expensive than no stoma, despite the cost-savings associated with a reduced frequency of anastomotic leakage. Both groups required the same total number of days with a stoma within five years of LAR.
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