Society of Black Academic Surgeons| Volume 211, ISSUE 4, P710-715, April 2016

Download started.


Race and socioeconomic disparities in national stoma reversal rates

Published:January 05, 2016DOI:



      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.


      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.


      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).


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Turnbull G.B.
        The ostomy files: ostomy statistics: the $64000 question.
        Ostomy Wound Manage. 2003; 49: 22-23
        • Godat L.
        • Kobavashi I.
        • Chang D.C.
        • et al.
        Do trauma stomas ever get reversed?.
        J Am Coll Surg. 2014; 219: 70-77
        • Daluvoy S.
        • Gonzalez F.
        • Vaziri K.
        • et al.
        Factors associated with ostomy reversal.
        Surg Endosc. 2008; 22: 2168-2170
        • Maggard M.A.
        • Zingmond D.
        • O’Connell J.B.
        • et al.
        What proportion of patients with an ostomy (for diverticulitis) get reversed?.
        Am Surg. 2004; 70: 928-931
        • Mols F.
        • Lemmens V.
        • Bosscha K.
        • et al.
        Living with the physical and mental consequences of an ostomy: a study among 1-10 year rectal cancer survivors from the population-based PROFILES registry.
        Psychooncology. 2014; 23: 998-1004
        • Fucini C.
        • Gattai R.
        • Urena C.
        • et al.
        Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma.
        Ann Surg Oncol. 2008; 15: 1099-1106
        • Dodgion C.M.
        • Neville B.A.
        • Lipsitz S.R.
        • et al.
        Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?.
        J Surg Res. 2013; 183: 238-245
        • Tokode O.M.
        • Akingboye A.
        • Coker O.
        Factors affecting reversal following Hartmann’s procedure: experience from two district general hospitals in the UK.
        Surg Today. 2011; 41: 79-83
        • Lidor A.O.
        • Gearhart S.L.
        • Wu A.W.
        • et al.
        Effect of race and insurance status on presentation, treatment, and mortality in patients undergoing surgery for diverticulitis.
        Arch Surg. 2008; 143: 1160-1165
        • HCUP Databases
        Healthcare Cost and Utilization Project (HCUP).
        Agency for Healthcare Research and Quality, Rockville, MD2015 (Available at:) (Accessed January 15, 2016)
        • Chow A.
        • Tilney H.S.
        • Paraskeva P.
        • et al.
        The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases.
        Int J Colorectal Dis. 2009; 24: 711-723
        • Gessler B.
        • Haglind E.
        • Angenete E.
        Loop ileostomies in colorectal cancer patients—morbidity and risk factors for nonreversal.
        J Surg Res. 2012; 178: 708-714
        • Siassi M.
        • Hohenberger W.
        • Losel F.
        • et al.
        Quality of life and patient’s expectations after closure of a temporary stoma.
        Int J Colorectal Dis. 2008; 23: 1207-1212
        • Rubio-Perez I.
        • Leon M.
        • Pastor D.
        • et al.
        Increased postoperative complications after protective ileostomy closure delay: an institutional study.
        World J Gastrointest Surg. 2014; 6: 169-174
        • Floodeen H.
        • Lindgren R.
        • Matthiessen P.
        When are defunctioning stomas in rectal cancer surgery really reversed? Results from a population-based single center experience.
        Scand J Surg. 2013; 102: 246-250
        • Alizai P.H.
        • Schulze-Hagen M.
        • Klink C.D.
        • et al.
        Primary anastomosis with a defunctioning stoma versus Hartmann’s procedure for perforated diverticulitis—a comparison of stoma reversal rates.
        Int J Colorectal Dis. 2013; 28: 1681-1688
        • Lim S.W.
        • Kim H.J.
        • Kim C.H.
        • et al.
        Risk factors for permanent stoma after low anterior resection for rectal cancer.
        Langenbecks Arch Surg. 2013; 398: 259-264
        • Williams N.S.
        Stoma reversal: limitations and pitfalls.
        Lancet Oncol. 2007; 8: 278-279
        • Alkire B.C.
        • Raykar N.P.
        • Shrime M.G.
        • et al.
        Global access to surgical care: a modeling study.
        Lancet Glob Health. 2015; 3: e316-e323
        • Hayanga A.J.
        • Kaiser H.E.
        • Sinha R.
        • et al.
        Residential segregation and access to surgical care by minority populations in us counties.
        J Am Coll Surg. 2009; 208: 1017-1022
        • LaVeist T.A.
        • Gaskin D.J.
        • Richard P.
        The Economic Burden of Health Inequalities in the United States.
        Joint Center for Political and Economic Studies, Washington, DC2009