title: Cost analysis of early versus delayed loop ileostomy closure: a case-matched study.
abstract: OBJECTIVE
  The optimal timing for the closure of loop ileostomies remains controversial. The aim of the current study was to investigate whether early ileostomy closure (EC) (<2 weeks post-formation) results in significant healthcare savings as against late closure (LC).
  
  
  METHODS
  Patients with available cost data that underwent EC between January 2008 and December 2012 were compared against matched patients undergoing LC during the same period. Direct hospital costs for the two groups were compared.
  
  
  RESULTS
  There were 42 EC patients and 61 LC patients. EC patients had significantly less ileostomy-related complications (p < 0.001) and hospital readmissions (p < 0.001). Operative time (p < 0.001) and operative cost (p = 0.002) were also both significantly less in the EC group. Community nursing costs favoured the LC group (p = 0.047). The EC group had an increased post-closure wound infection rate (p = 0.02). The mean total direct cost per patient was NZD 13,724 (SD NZD 3,736) for EC and NZD 16,728 (SD NZD 8,028) for LC. Representing an average costs saving of NZD 3,004 per patient favouring EC (p = 0.012).
  
  
  CONCLUSIONS
  Although EC increases the post-closure wound infection rate, EC reduces ileostomy complications, hospital readmissions and operative costs resulting in significant healthcare savings. In order to improve patient outcomes and make EC even more cost effective, efforts should be taken to reduce wound infections.
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Jason
authors.initials: J
authors.lastname: Robertson
authors.forename: Hannah
authors.initials: H
authors.lastname: Linkhorn
authors.forename: Ryash
authors.initials: R
authors.lastname: Vather
authors.forename: Rebekah
authors.initials: R
authors.lastname: Jaung
authors.forename: Ian P
authors.initials: IP
authors.lastname: Bissett
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007081:Ileostomy / Q000191:economics*; D007082:Ileum / Q000601:surgery; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009520:New Zealand; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics; D013997:Time Factors