Abstract
Background
Many temporary stomas are never reversed leading to significantly worse quality of
life. Recent evidence suggests a lower rate of reversal among minority patients. Our
study aimed to elucidate disparities in national stoma closure rates by race, medical
insurance status, and household income.
Methods
Five years of data from the Nationwide Inpatient Sample (2008 to 2012) was used to
identify the annual rates of stoma formation and annual rates of stoma closure. Stomas
labeled as “permanent” or those created secondary to colorectal cancers were excluded.
Temporary stoma closure rates were calculated, and differences were tested with the
chi-square test. Separate analyses were performed by race/ethnicity, insurance status,
and household income. Nationally representative estimates were calculated using discharge-level
weights.
Results
The 5-year average annual rate of temporary stoma creation was 76,551 per year (46%
colostomies and 54% ileostomies). The annual rate of stoma reversal was 50,155 per
year that equated to an annual reversal rate of 65.5%. Reversal rates were higher
among white patients compared with black patients (67% vs 56%, P < .001) and among privately insured patients compared with uninsured patients (88%
vs 63%, P < .001). Reversal rates increased as the household income increased from 61% in the
lowest income quartile to 72% in the highest quartile (P < .001).
Conclusions
Stark disparities exist in national rates of stoma closure. Stoma closure is associated
with race, insurance, and income status. This study highlights the lack of access
to surgical health care among patients of minority race and low-income status.
Keywords
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Article info
Publication history
Published online: January 05, 2016
Received in revised form:
October 1,
2015
Received:
June 2,
2015
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
