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Impact of parastomal hernia on colostomy costs at 1 year: secondary analysis of a randomized clinical trial (STOMAMESH)
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Division of Surgery, Sunderby Hospital, Luleå, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.ORCID iD: 0000-0002-3806-2114
Department of Business Administration and Industrial Engineering, Luleå University of Technology, Luleå, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
2024 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 113, no 1, p. 33-39Article in journal (Refereed) Published
Abstract [en]

Background and aims: Parastomal hernia (PSH) is a common complication after the creation of a colostomy, with a prevalence of approximately 50%. Despite the high frequency, little is known how PSH affects the cost of colostomy care. The hypothesis in this study was that PSH increases the cost of colostomy care compared with not having a PSH.

Methods: Two groups with (N = 61) and without (n = 147) PSH were compared regarding costs of stoma appliances and visits. The population from a large randomized trial comparing construction of colostomy with or without prophylactic mesh (STOMAMESH) was used and cross-matched with health economic data from the National Pharmaceutical Register, 1 year after initial surgery.

Results: Patients with and without a PSH were similar in basic demographic data. No difference in cost of stoma appliances (with PSH 2668.3 EUR versus no PSH 2724.5 EUR, p = 0.938) or number of visits to a stoma therapist (p = 0.987) was seen, regardless of the presence or not of a PSH.

Conclusions: PSH appears not to affect costs due to colostomy appliances or the need to visit a stoma therapist, in the first year. The lesson to be learnt is that PSHs are not a driver for costs. Other factors may be determinants of the cost of a colostomy, including manufacturers' price and persuasion, means of procurement, and presence of guidelines.

Place, publisher, year, edition, pages
Sage Publications, 2024. Vol. 113, no 1, p. 33-39
Keywords [en]
Colostomy, health economy, parastomal hernia
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-213413DOI: 10.1177/14574969231188021ISI: 001046532600001PubMedID: 37563916Scopus ID: 2-s2.0-85167775479OAI: oai:DiVA.org:umu-213413DiVA, id: diva2:1791602
Funder
Swedish Research Council, 214-7196Norrbotten County CouncilRegion Västerbotten, RV-927121Available from: 2023-08-25 Created: 2023-08-25 Last updated: 2024-05-02Bibliographically approved
In thesis
1. Aspects of parastomal hernia
Open this publication in new window or tab >>Aspects of parastomal hernia
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Parastomal hernia (PSH) is a common complication to all ostomies, and all too well known to colorectal surgeons. Up to half of all stomates get a PSH. PSH may present itself as a protrusion or a bulge of the stoma that contains bowel or other content of the abdominal cavity. The symptom load varies from none to debilitating. An unknown fraction of patients with PSH receives correctional surgery. The overall aim of this thesis was to investigate prevalence and treatment of PSH in Sweden, explore whether prophylactic mesh when constructing a colostomy is a viable option for prevention, investigate the health economic impact of PSH and probe into the patient’s own experiences of living with a PSH. The thesis is based on both qualitative and quantitative research. Paper I and III are a randomised controlled multicentre trial, paper II is retrospective audit of the treatment of PSH in Sweden, paper IV is a health economic analysis of colostomy costs and paper V is an interview of survivors of colorectal cancer, with a colostomy and PSH.

The conclusions are as follows: The frequency of PSH surgery was much lower than expected, no specific risk factor could be identified, and perhaps centralisation of surgery should be considered. Most common cause for surgery was cosmetic. Prophylactic mesh in a sublay position don’t prevent PSH but doesn’t seem to add significant complications. PSH cost no more than a colostomy with no PSH, regarding appliances and stoma nurse visits. The common theme of long-time rectal cancer survivors with PSH is coping and a deep sense of gratitude being a survivor.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2023. p. 72
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2262
Keywords
parastomal hernia, colostomy, surgical technique, patient experience
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-216046 (URN)978-91-8070-170-9 (ISBN)978-91-8070-171-6 (ISBN)
Public defence
2023-12-01, Aulan, Sunderby sjukhus, Sjukhusvägen 12, Sunderby, 10:00 (English)
Opponent
Supervisors
Available from: 2023-11-10 Created: 2023-10-31 Last updated: 2023-11-01Bibliographically approved

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Odensten, ChristofferGunnarsson, UlfNäsvall, Pia

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