title: Determinants of stoma reversal in rectal cancer patients who had an anterior resection between 2009 and 2012 in the English National Health Service.
abstract: OBJECTIVE
  The rate of ileostomy reversal was estimated in patients undergoing an elective anterior resection for rectal cancer and factors associated with reversal were identified.
  
  
  METHODS
  The records of 4879 rectal patients who had an ileostomy created during anterior resection between 2009 and 2012 were identified in the National Bowel Cancer Audit database and linked to administrative records of the Hospital Episode Statistics. Patients were followed from surgery. Multivariable proportional hazards regression was used to estimate the impact of patient and cancer characteristics on ileostomy reversal with death as the competing risk.
  
  
  RESULTS
  Within 18 months from anterior resection, 3536 (72.5%) patients had undergone ileostomy reversal. The reversal rate was lower in the following circumstances: older patients [hazard ratio (HR) 0.90; 95% CI 0.84-0.96, aged 80 vs 70 years], male gender (HR 0.90; 0.84-0.97), higher American Society of Anesthesiologists (ASA) grade (HR 0.64; 0.56-0.74, ASA 3+ vs 1), more advanced cancer (HR 0.77; 0.69-0.87, T3 vs T1), socioeconomic deprivation (HR 0.83; 0.74-0.93, most vs least deprived quintile), comorbidity (HR 0.92; 0.84-1.00, one vs no comorbidity) and open surgical procedure (HR 0.90; 0.84-0.97, open vs laparoscopic).
  
  
  CONCLUSIONS
  Overall, two-thirds of ileostomies were reversed within 18 months. Reversal rates were linked to patient and cancer characteristics (age, sex, fitness and stage), mode of surgical access and socioeconomic deprivation. Observed lower reversal rates in patients from poorer backgrounds may indicate inequity in access.
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Kuryba
authors.affiliation: Colorectal Surgical Department, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.
authors.forename: N A
authors.initials: NA
authors.lastname: Scott
authors.affiliation: Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hill
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.|Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: van der Meulen
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.|Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Walker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D003106:Colon / Q000601:surgery*; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data; D007082:Ileum / Q000601:surgery*; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D008875:Middle Aged; D009313:National Health Programs; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D006113:United Kingdom / Q000453:epidemiology
keywords: Rectal cancer; anterior resection; ileostomy; stoma; surgery