Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma

• Published in: International Journal of Colorectal Disease
• Main Authors: Näverlo, Simon, Strigård, Karin, Gunnarsson, Ulf
• Format: Article in Journal/Newspaper
• Language: English
• Published: Umeå universitet, Kirurgi 2019
• Subjects: Defunctioning stoma; Distance; Permanent stoma; Rectal cancer; Rural; Stoma reversal; Surgery; Kirurgi; Northern Sweden
• Online Access: http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-156475; https://doi.org/10.1007/s00384-019-03258-6

PURPOSE: To see if road distance to hospital influences stoma reversal rate, time from index operation to stoma reversal, and occurrence of permanent stoma. METHODS: Data from all diagnosed cases of rectal cancer from three counties in northern Sweden were extracted from the Swedish Rectal Cancer Registry. The three counties are sparsely populated, with a population density roughly one fifth the average density in Sweden. Distances to nearest, operating, and largest hospital were obtained using Google Maps™. Matched data on socioeconomic variables were retrieved from Statistics Sweden. RESULTS: In univariate logistic regression analysis, patients living closer to the operating hospital had a higher likelihood of non-reversal than those living farther away (OR 0.3; 95% CI 0.12-0.76). However, no difference was seen in the multivariate analysis. Of the 717 cases included, 54% received a permanent stoma and 38% a defunctioning stoma at index surgery. The reversal rate of a defunctioning stoma was 83%. At follow-up, 61% still had a stoma, 89% of these were permanent, and 11% non-reversed defunctioning stomas. Median time to stoma reversal was 287 days (82-1557 days). Of all 227 stoma reversals, 77% were done more than 6 months after index surgery. CONCLUSIONS: Longer distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. Only 23% had their defunctioning stoma reversed within 6 months after index surgery. Future studies aiming to determine reversal rate need to extend their follow-up time in order to receive accurate results.