Costs and Resource Use following Defunctioning Stoma in Low Anterior Resection for Cancer-A long-term analysis of a randomized multicenter trial

Publication date: Available online 21 December 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Hannah Floodeen, Olof Hallböök, Lars A. Hagberg, Peter Matthiessen
BackgroundDefunctioning 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.MethodFive-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.ResultsAverage 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=34068). 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.ConclusionRandomization 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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