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Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution.
Khoo, Michelle Shi Qing; Koh, Frederick H; Sivarajah, Sharmini Su; Ho, Leonard Ming-Li; Aw, Darius Kang-Lie; Chong, Cheryl Xi-Zi; Foo, Fung Joon; Tan, Winson Jianhong.
Afiliación
  • Khoo MSQ; Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
  • Koh FH; Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
  • Sivarajah SS; Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
  • Ho LM; Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
  • Aw DK; Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
  • Chong CX; Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
  • Foo FJ; Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
  • Tan WJ; Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
Ann Coloproctol ; 2024 Aug 05.
Article en En | MEDLINE | ID: mdl-39107229
ABSTRACT

Purpose:

In patients with acute left-sided colonic obstruction, stenting can convert an emergency operation into a semi-elective procedure. However, its use continues to be debated. We performed a cost-effective analysis using our institution's experiences.

Methods:

Endoscopic, surgical, and financial details were prospectively collected for patients who presented with acute colonic obstruction and underwent stenting between 2019 and 2022. Outcomes were defined as technical/clinical success and successful surgical resection. The financial cost of stenting was compared with the expected cost without stenting.

Results:

Forty patients were included, with 29 undergoing definitive resection. The most common pathology was primary colon cancer (27 patients, 93%). Endoscopic stenting had high technical (90%) and clinical (83%) success rates, with low rates of complications such as perforation (2 patients, 7%) and migration (0 patients, 0%). As a bridge to surgery, the median procedure time was 226 minutes and the surgical outcomes also showed a low rate of complications (3 patients, 11%), such as anastomotic leakage (0 patients, 0%), intraabdominal abscesses (2 patients, 7%), and 30-day postoperative mortality (0 patients, 0%). The cumulative costs with colonic stenting were $32,900, while the expected costs with emergency surgery, including stoma reversal, were $40,700 (healthcare cost-savings of $7,800 per person). The difference was mainly due to the avoidance of upfront emergency surgery. The incremental cost-effectiveness ratio was 0.81, favoring colonic stenting over upfront emergency surgery.

Conclusion:

Colonic stenting as a bridge to surgery is safe and cost-effective for treating left-sided colonic obstruction with high success rates and low complication rates.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Coloproctol Año: 2024 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Corea del Sur
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Coloproctol Año: 2024 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Corea del Sur