Cost-effectiveness analysis of the temporary percutaneous ileostomy for faecal diversion after colorectal resection in elderly.
BACKGROUND
Conventional loop ileostomy (CLI) is a suitable procedure for transitory faecal diversion after colorectal anastomosis, but it causes relevant morbidities (dehydration, discomfort, peristomal infections) and requires a second operation to be closed. We already described an alternative technique of temporary percutaneous ileostomy (TPI), which can be removed without surgery.


OBJECTIVE
We analyse the outcomes and the costs of the TPI in protecting low colorectal anastomosis in elderly, compared to the CLI.


METHODS
Data of patients underwent elective anterior rectal resection for rectal cancer with extra-peritoneal colorectal anastomosis protected by ileostomy from January 2011 to December 2015 were reviewed. Sixty-one out of 132 patients were older than 70; 35 underwent faecal diversion by TPI and 26 by CLI.


RESULTS
The two groups resulted homogenous about age, sex, operative time, short-term post-operative complications. None of the patients reported anastomotic leakage. The hospital stay and the cost for the first surgical procedure did not show statistically significant differences between TPI and CLI. When comparing the overall hospital stay and costs the differences are statistically significant: the TPI showed a shorter hospital stay (12.4 vs 19.3 days, -35.7%) and a lower cost of hospitalization (7954.0 vs 14,372.1€, -44.7%), compared to CLI.


CONCLUSIONS
The limited duration of the faecal diversion and the uselessness of a second surgical procedure to remove the TPI are the most important advantages of TPI, especially in elderly.


CONCLUSIONS
The TPI not only improved the post-operative outcome of the patients, but also allowed a remarkable saving for the National Health System.
General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy. walterbugiantella@alice.it.|PhD School of Biotechnologies, University of Perugia, Piazza Università, 06100, Perugia, Italy. walterbugiantella@alice.it.
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Bugiantella
General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.|Department of Surgical and Biomedical Sciences, University of Perugia, Via G. Dottori, 06100, Perugia, Italy.
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Rondelli
General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
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Mariani
General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
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Polistena
General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
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Sanguinetti
General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
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Avenia
General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
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Mariani
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000601:surgery; D013997:Time Factors
Colorectal anastomosis; Cost; Faecal diversion; Percutaneous ileostomy; Probe