title: Costs and resource use following defunctioning stoma in low anterior resection for cancer - A long-term analysis of a randomized multicenter trial.
abstract: BACKGROUND
  Defunctioning stoma in low anterior resection (LAR) for rectal cancer can prevent major complications, but overall cost-effectiveness for the healthcare provider is unknown. This study compared inpatient healthcare resources and costs within 5 years of LAR between two randomized groups of patients undergoing LAR with and without defunctioning stoma.
  
  
  METHODS
  Five-year follow-up of a randomized, multicenter trial on LAR (NCT 00636948) with (stoma; n = 116) or without (no stoma; n = 118) defunctioning stoma comparing inpatient healthcare resources and costs. Unplanned stoma formation, days with stoma, length of hospital stay, reoperations, and total associated inpatient costs were analyzed.
  
  
  RESULTS
  Average costs were € 21.663 per patient with defunctioning stoma and € 15.922 per patient without defunctioning stoma within 5 years of LAR, resulting in an average cost-saving of € 5.741. There was no difference between groups regarding the total number of days with any stoma (stoma = 33 398 vs. no stoma = 34 068). The total number of unplanned reoperations were 70 (no stoma) and 32 (stoma); p < 0.001. In the group randomized to no stoma at LAR, 30.5% (36/118) required an unplanned stoma later.
  
  
  CONCLUSIONS
  Randomization to defunctioning stoma in LAR was more expensive than no stoma, despite the cost-savings associated with a reduced frequency of anastomotic leakage. Both groups required the same total number of days with a stoma within five years of LAR.
authors.affiliation: Department of Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Fakultetsgatan 1, 70182 Örebro, Sweden. Electronic address: hfloodeen@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Floodeen
authors.affiliation: Department of Surgery, Linköping University Hospital, 58183 Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden. Electronic address: olof.hallbook@regionostergotland.se.
authors.forename: O
authors.initials: O
authors.lastname: Hallböök
authors.affiliation: Center for Health Care Science, Örebro County Council, 70182 Örebro, Sweden. Electronic address: lars.hagberg@oru.se.
authors.forename: L A
authors.initials: LA
authors.lastname: Hagberg
authors.affiliation: Department of Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Fakultetsgatan 1, 70182 Örebro, Sweden. Electronic address: peter.matthiessen@regionorebrolan.se.
authors.forename: P
authors.initials: P
authors.lastname: Matthiessen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003125:Colostomy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics*; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation / Q000191:economics; D012307:Risk Factors; D013548:Sweden
keywords: Anastomotic leak; Costs and cost analysis; Defunctioning stoma; Health resources; Rectal cancer