The true cost of protective loop colostomy

Transverse loop colostomies are commonly used to "protect" low colorectal anastomoses after anterior resection for rectal carcinoma. However, anastomotic leaks occur despite proximal decompression. We studied 61 consecutive patients who underwent anterior resection to evaluate the cost of loop colostomy as reflected by morbidity, mortality, and length of post-operative hospital stay. Colostomy patients had significantly greater blood loss (736 vs. 500 ml, p = 0.004), more blood transfusions (1.55 units vs. 0.41 units, p less than 0.001), and longer operations (238 vs. 193 min, p = 0.005). They were also older (68 vs. 65, p = 0.13), had lesions closer to the anal verge (10.2 vs. 11.4 cm, p = 0.07), and had more infectious complications (13.6% vs. 2.6%, 0.05 less than p less than 0.1) than patients without colostomies. Colostomy was not related to sex or stage. There were no anastomotic leaks among those with colostomies and only one among those without colostomies; there were no associated mortalities. Patients with colostomies stayed an additional 10 days, on average, when readmitted for colostomy closure. The 22 patients who received loop colostomies had postoperative stays averaging one-third longer than patients without colostomies (16 vs. 12 days, p = 0.004). In both groups, the 8th postoperative day was the mean for resumption of a regular diet; all patients were eating a regular diet by the 12th postoperative day. The delay in discharging colostomy patients was due to the additional time necessary for patients to learn to change their appliance and irrigate their stoma. Proximal diverting colostomies may more than double the total dollar cost of anterior resection, although DRG reimbursement is the same with or without a colostomy. This additional cost could be reduced by initiating ostomy teaching in the preoperative period and by reducing the use of unnecessary colostomies.