title: Late vs early ostomy closure for necrotizing enterocolitis: analysis of adhesion formation, resource consumption, and costs.
abstract: BACKGROUND
  Surgeons prefer to close ostomies at least 6 weeks after the primary operation because of the anticipated postoperative abdominal adhesions. Limited data support this habit. Our aim was to evaluate adhesion formation-together with an analysis of resource consumption and costs-in patients with necrotizing enterocolitis who underwent early closure (EC), compared with a group of patients who underwent late closure (LC).
  
  
  METHODS
  Chart reviews and cost analyses were performed on all patients with necrotizing enterocolitis undergoing ostomy closure from 1997 to 2009. Operative reports were independently scored for adhesions by 2 surgeons.
  
  
  RESULTS
  Thirteen patients underwent EC (median, 39 days; range, 32-40), whereas 62 patients underwent LC (median, 94 days; range, 54-150). Adhesion formation in the EC group (10/13 patients, or 77%) was not significantly different (P = 1.000) from the LC group (47/59 patients, or 80%). No differences were found in the costs of hospital stay, surgical interventions, and outpatient clinic visits.
  
  
  CONCLUSIONS
  Ostomy closure within 6 weeks of the initial procedure was not associated with more adhesions or with changes in direct medical costs. Therefore, after stabilization of the patient, ostomy closure can be considered within 6 weeks during the same admission as the initial laparotomy.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Struijs
authors.forename: Marten J
authors.initials: MJ
authors.lastname: Poley
authors.forename: Conny J H M
authors.initials: CJ
authors.lastname: Meeussen
authors.forename: Gerard C
authors.initials: GC
authors.lastname: Madern
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Richard
authors.initials: R
authors.lastname: Keijzer
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000191:economics / Q000601:surgery*; D004766:Enterostomy / Q000191:economics / Q000379:methods; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome