In a select group of patients meeting strict clinical criteria and undergoing ileal pouch-anal anastomosis, the omission of a diverting ileostomy offers cost savings to the hospital.
OBJECTIVE
Ileal pouch-anal anastomosis is the standard care for the majority of patients with ulcerative colitis or familial adenomatous polyposis requiring surgery. The aim of this study is to determine whether the omission of an ileostomy in patients undergoing ileal pouch surgery offers cost savings to the hospital.


METHODS
Patients who underwent open ileal pouch-anal anastomosis between 2000 and 2007 were identified. They were grouped according to the absence or presence of an ileostomy at the time of their surgery. Direct costs were calculated from the hospital's accounting database. Costs analyzed included those from the index surgery, ileostomy closure, and 6-month complications.


RESULTS
Cost data were available for 835 patients undergoing ileal pouch-anal anastomosis. Seven hundred fifteen (86%) had a diverting ileostomy, and the ileostomy was omitted in 120 (14%). Patients without an ileostomy had a longer length of stay (8.7 vs 6.0 days; P < .001) and a 15% greater cost (P < .001) at the time of index surgery than did those with an ileostomy. There was no significant difference between the 2 groups in costs related to complications. The total costs, including ileal pouch-anal anastomosis, ileostomy closure, and complications, were 25% greater in the ileostomy group than in the group who had the ileostomy omitted at the index surgery ($9176 (+/- 6559) vs $11,451 (+/- 8791); P < .001).


CONCLUSIONS
The above data shows that in a select group of patients meeting well-defined clinical criteria, the omission of a diverting ileostomy will provide significant cost savings for the hospital.
Joyce
Myles R
MR
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Kiran
Ravi P
RP
Remzi
Feza H
FH
Church
James
J
Fazio
Victor W
VW
D000328:Adult; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D039021:Colonic Pouches / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome