Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution
10.3393/ac.2023.00738.0105
- Author:
Michelle Shi Qing KHOO
1
;
Frederick H. KOH
;
Sharmini Su SIVARAJAH
;
Leonard Ming-Li HO
;
Darius Kang-Lie AW
;
Cheryl Xi-Zi CHONG
;
Fung Joon FOO
;
Winson Jianhong TAN
Author Information
1. Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore
- Publication Type:Original Article
- From:Annals of Coloproctology
2024;40(6):555-563
- CountryRepublic of Korea
- Language:English
-
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.
