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Cost-effectiveness analysis of the temporary percutaneous ileostomy for faecal diversion after colorectal resection in elderly

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Abstract

Background

Conventional loop ileostomy (CLI) is a suitable procedure for transitory faecal diversion after colorectal anastomosis, but it causes relevant morbidities (dehydration, discomfort, peristomal infections) and requires a second operation to be closed. We already described an alternative technique of temporary percutaneous ileostomy (TPI), which can be removed without surgery.

Aims

We analyse the outcomes and the costs of the TPI in protecting low colorectal anastomosis in elderly, compared to the CLI.

Methods

Data of patients underwent elective anterior rectal resection for rectal cancer with extra-peritoneal colorectal anastomosis protected by ileostomy from January 2011 to December 2015 were reviewed. Sixty-one out of 132 patients were older than 70; 35 underwent faecal diversion by TPI and 26 by CLI.

Results

The two groups resulted homogenous about age, sex, operative time, short-term post-operative complications. None of the patients reported anastomotic leakage. The hospital stay and the cost for the first surgical procedure did not show statistically significant differences between TPI and CLI. When comparing the overall hospital stay and costs the differences are statistically significant: the TPI showed a shorter hospital stay (12.4 vs 19.3 days, −35.7%) and a lower cost of hospitalization (7954.0 vs 14,372.1€, −44.7%), compared to CLI.

Discussion

The limited duration of the faecal diversion and the uselessness of a second surgical procedure to remove the TPI are the most important advantages of TPI, especially in elderly.

Conclusion

The TPI not only improved the post-operative outcome of the patients, but also allowed a remarkable saving for the National Health System.

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Abbreviations

TPI:

Temporary percutaneous ileostomy

CLI:

Conventional loop ileostomy

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Authors and Affiliations

  1. General Surgery, “San Giovanni Battista Hospital”, AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy

    W. Bugiantella, F. Rondelli, L. Mariani & E. Mariani

  2. PhD School of Biotechnologies, University of Perugia, Piazza Università, 06100, Perugia, Italy

    W. Bugiantella

  3. Department of Surgical and Biomedical Sciences, University of Perugia, Via G. Dottori, 06100, Perugia, Italy

    F. Rondelli

  4. General and Specialized Surgery, “Santa Maria” Hospital, Via T. Di Joannuccio, 05100, Terni, Italy

    A. Polistena, A. Sanguinetti & N. Avenia

Authors
  1. W. Bugiantella
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  2. F. Rondelli
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  3. L. Mariani
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  4. A. Polistena
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  5. A. Sanguinetti
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  6. N. Avenia
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  7. E. Mariani
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Corresponding author

Correspondence to W. Bugiantella.

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Conflict of interest

All authors listed have contributed sufficiently to the project to be included as authors, and to the best of our knowledge, no conflict of interest, financial, or other exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

To the radiological and surgical procedure and to the processing of own personal data was obtained from each individual study participant. In accordance with Italian Drug Agency (AIFA) guidelines, observational studies using retrospective data or materials do not require formal approval by the local Ethics Committee.

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Bugiantella, W., Rondelli, F., Mariani, L. et al. Cost-effectiveness analysis of the temporary percutaneous ileostomy for faecal diversion after colorectal resection in elderly. Aging Clin Exp Res 29 (Suppl 1), 47–53 (2017). https://doi.org/10.1007/s40520-016-0658-7

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  • DOI: https://doi.org/10.1007/s40520-016-0658-7

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