| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 98 === Backgrouds The ostomy rate is about 30% after resection for patients with colorectal cancer. Ostomy could substitute for anal function and avoid postoperative anastomotic leakage after colorectal surgery, including low anterior resection, abdomen perineum resection, Hartmann's resection, anterior resection and sub-total colectomy for patients. According to foreign studies, different types of ostomy affect the length of hospital stay and complications in patients. Domestic researches studied in medical records of single hospital or claim database but have not yet discussed the length of stay and postoperative complications of ostomy after colorectal surgery for patients with colorectal cancer.
Objects The aim of study was to understand the distribution of using ostomy in colorectal cancer resection patients and explore the effects of ostomy after colorectal surgery on the length of stay and postoperative complications in colorectal cancer patients.
Methods A historical cohort method is adopted to conduct the study. After identification of newly diagnosed patients in colorectal cancer from Taiwan Cancer Database(TCDB) in 2003-2006, the information will connect with the census registry and databases of the Bureau of National Health Insurance (BNHI) in 2002-2007. SAS statistical software (version 9.1.3) was used for analysing hospital stay based on t-test and one-way ANOVA and for analysing complications based on chi-square test. Stepwise multiple regression and stepwise logistic regression were used after adjusting the patient’s characteristics.
Results In 2003-2006, a total of 15,805 patients with colorectal surgery were included, and 27.11% were treated with ostomy, while 90.45% were colostomy and 9.55% were ileostomy. The length of hospital stay for patients was affected by types of ostomy, sex, age, marital status, comorbidity, tumor location, hospital ownership, grades, and the volume of surgical services. The length of hospital stay for patients in low anterior resection was affected by types of ostomy, sex, age, marital status, comorbidity, tumor location, tumor stages, hospital ownership and the volume of surgical services. The length of hospital stay for patients in anterior resection was affected by sex, age, comorbidity, emergency status, tumor stages and hospital grades. The length of hospital stay for patients in sub-total colectomy resection was affected by types of ostomy, age, comorbidity, hospital ownership and the volume of surgical services. The postoperative complications for patients in the hospital stay were affected by types of ostomy, sex, age, marital status, comorbidity, emergency status, tumor location, resection type, hospital ownership, grades and the volume of surgical services. The adjusted OR of ileostomy was 1.44 to colostomy. The postoperative complications for patients in low anterior resection were affected by types of ostomy, sex, age, comorbidity, emergency status, hospital ownership and grades. The adjusted OR for ileostomy was 1.51 to colostomy. The postoperative complications patients in the anterior resection were affected by emergency status. The postoperative complications for patients in sub-total colectomy were affected by types of ostomy, sex, age, comorbidity, tumor location. The adjusted OR of ileostomy was 0.06 to colostomy.
Conclusions The length of stay for patients with ileostomy was shorter than it for patients with colostomy. The risk of postoperative complications for ileostomy was higher than colostomy. So clinicians should carefully assess the patients’ risks and choosing the most appropriate type of ostomy for the patients.
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