{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T13:45:43Z","timestamp":1779371143612,"version":"3.53.1"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Defunctioning loop ileostomies (DLIs) are a frequent adjunct to rectal cancer surgery. Delayed closure of DLIs is common and associated with increased morbidity. The reasons for delayed DLI closure are often unknown. The economic burden of delayed DLI closure is not quantified. The present study aimed to determine the reasons for, and economic burden of, delayed DLI closure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical and economic data were audited from a prospective database of patients in two Australasian colorectal cancer centres. Patients treated at each unit with low\/ultra\u2010low anterior resection for rectal cancer with formation of DLI between January 2014 and December 2019 were included. Post\u2010operative complication rate, stoma\u2010related complication rate and costs of hospital admissions and stoma care were recorded and analysed. Multivariate linear regression analysis was used to investigate risk factors for delay to closure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>146 patients underwent low\/ultra\u2010low anterior resection with DLI; 135 patients (92.5%) underwent reversal. The median duration to reversal was 7\u00a0months (IQR 4.5\u20139.5). Sixty\u2010six percent of patients underwent reversal &gt;6\u00a0months after their index surgery. Neoadjuvant and adjuvant chemotherapy were associated with delayed reversal (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001). Non\u2010English speakers waited longer for DLI closure (<jats:italic>P<\/jats:italic>\u00a0=\u20090.028). The costs of outpatient stoma care (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001), post\u2010operative care (<jats:italic>P<\/jats:italic>\u00a0=\u20090.004), and total cost of treatment (<jats:italic>P<\/jats:italic>\u00a0=\u20090.014) were significantly higher in the delayed closure group, with a total cost of treatment difference of $3854 NZD per patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Causes of delay include systemic factors and demographic factors that can be addressed directly, addressing such causes may alleviate a significant economic burden.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.18092","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T06:10:19Z","timestamp":1665123019000},"page":"636-642","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Causes and costs of delayed closure of ileostomies in rectal cancer patients in Australasian units"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1756-3649","authenticated-orcid":false,"given":"Jon","family":"Barnard","sequence":"first","affiliation":[{"name":"Coloreectal Unit Royal Adelaide Hospital  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Milne","sequence":"additional","affiliation":[{"name":"General Surgery Nelson Hospital  Nelson New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Teo","sequence":"additional","affiliation":[{"name":"General Surgery Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maree","family":"Weston","sequence":"additional","affiliation":[{"name":"General Surgery Middlemore Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lincoln","family":"Israel","sequence":"additional","affiliation":[{"name":"General Surgery Middlemore Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sze\u2010Lin","family":"Peng","sequence":"additional","affiliation":[{"name":"General Surgery Middlemore Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Bowel Cancer Quality Improvement Report","author":"Bissett IJ","year":"2019"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-18-0523"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.15552"},{"key":"e_1_2_10_5_1","article-title":"Covering ileo\u2010 or colostomy in anterior resection for rectal carcinoma","volume":"5","author":"Montedori A","year":"2010","journal-title":"Cochrane Database Syst. 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