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The true cost of protective loop colostomy.
C A Peller1, O Froymovich, P I Tartter
1Department of Surgery, Mount Sinai Medical Center, New York, New York.
The American Journal of Gastroenterology
|September 1, 1989
Summary
Transverse loop colostomies increase surgical complications, blood loss, and hospital stay after rectal cancer surgery. Reducing their use and improving patient education can lower costs and improve outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Transverse loop colostomies are frequently employed to protect low colorectal anastomoses following anterior resection for rectal carcinoma.
- Despite their use, anastomotic leaks can still occur, necessitating an evaluation of the colostomy's overall impact.
Purpose of the Study:
- To assess the cost-effectiveness of loop colostomies in patients undergoing anterior resection for rectal cancer.
- To evaluate the impact of loop colostomies on morbidity, mortality, and postoperative hospital stay.
Main Methods:
- A study of 61 consecutive patients who underwent anterior resection for rectal carcinoma.
- Comparison of outcomes between patients with and without transverse loop colostomies.
- Analysis of blood loss, transfusion requirements, operation duration, infectious complications, and hospital stay.
Main Results:
- Colostomy patients experienced significantly greater blood loss, required more blood transfusions, and had longer operations.
- Infectious complications were more frequent in the colostomy group.
- Patients with colostomies had significantly longer postoperative hospital stays, averaging an additional 10 days upon readmission for closure.
Conclusions:
- Transverse loop colostomies are associated with increased morbidity and prolonged hospital stays, potentially doubling the total cost of anterior resection.
- No anastomotic leaks were observed in patients with colostomies, but this benefit may not outweigh the increased costs and complications.
- Preoperative ostomy education and judicious use of colostomies could mitigate associated costs and improve patient management.