{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:20:39Z","timestamp":1766067639304,"version":"3.40.5"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"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":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Following ultralow anterior resection for distal rectal cancers, a coloanal anastomosis is usually created along with a defunctioning ileostomy (DI). Recent evidence suggests that abdominoperineal pull\u2010through with delayed coloanal anastomosis (DCAA) is a viable alternative to immediate coloanal anastomosis (ICAA), minimizing the risk of anastomotic leakage and avoiding the need for stoma creation with the risk of stoma\u2010associated morbidity. However, DCAA requires a longer initial hospitalization. We aimed to perform a cost\u2010effectiveness analysis to compare DCAA versus ICAA for elective rectal cancer surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A decision tree model was used to compare the cost\u2010effectiveness of the two strategies. Cost data were obtained from the 2019 to 2020 United Kingdom National Health Service reference costs. Model probabilities were derived from published studies. Univariate and probabilistic sensitivity analyses were used to evaluate the robustness of the results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>DCAA was the overall cheaper strategy at \u00a313\u2009541 compared with \u00a314\u2009856 for ICAA in the base case analysis. This was explained by the decreased overall costs of hospitalization\/surgery, reduction in costs associated with anastomotic or stoma\u2010related complications, specifically dehydration\u2010induced hospital readmissions and avoidance of stoma maintenance costs. Sensitivity analysis demonstrated that DCAA remained consistently more inexpensive except when the duration of total parenteral nutrition exceeded 14\u2009days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite a longer index hospitalization with higher initial costs, this economic analysis demonstrates that DCAA without stoma is overall more cost\u2010effective compared with ICAA with DI following ultralow anterior resection. Cost savings should be considered an additional benefit when selecting the DCAA approach for rectal cancer surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.18148","type":"journal-article","created":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T04:45:25Z","timestamp":1668141925000},"page":"963-969","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost\u2010effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8742-8285","authenticated-orcid":false,"given":"Nicholas Brian","family":"Shannon","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8287-6812","authenticated-orcid":false,"given":"Isaac","family":"Seow\u2010En","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0771-5063","authenticated-orcid":false,"given":"Emile Kwong\u2010Wei","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Singapore General Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,11,10]]},"reference":[{"key":"e_1_2_8_2_1","article-title":"Mechanical bowel preparation for elective colorectal surgery","volume":"2011","author":"G\u00fcenaga KF","year":"2011","journal-title":"Cochrane Database Syst. 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