Racial Disparities After Stoma Construction Exist in Time to Closure After 1 Year but Not in Overall Stoma Reversal Rates

Academic Article

Abstract

  • © 2017, The Society for Surgery of the Alimentary Tract. Introduction: Conflicting data exist on racial disparities in stoma reversal (SR) rates. Our aim was to investigate the role of race in SR rates, and time to closure, in a longitudinal, racially diverse database. Methods: All adult patients (>18 years) who received an ileostomy or colostomy from 1999 to 2016 at a single institution were identified. Primary outcomes were SR rates and time to closure. Failure to reverse and time to closure was modeled using Cox regression. Kaplan-Meier survival curves, stratified by race, were generated for time to closure and hazard ratios (HRs) calculated. Results: Of 770 patients with stomas, 65.6% of patients underwent SR; 76.6% were white and 23.4% were black. On adjusted analysis, race did not predict overall SR rates or time to closure if performed less than 1 year. Instead, significant predictors for failure in SR included age, insurance status, end colostomy/ileostomy, and loop colostomy (p < 0.05). Predictors of delay in time to closure included insurance, end colostomy/ileostomy, and loop colostomy (p < 0.05). In patients who underwent reversal after 1 year, black race was an independent predictor of time to closure (HR 0.21, 95% CI 0.07–0.63, p < 0.05). Conclusion: SR rates were equal between black and white patients. Disparities in time to closure existed only for black patients if reversed more than 1 year after index stoma construction. While equitable outcomes were achieved for most patients, further investigation is necessary to understand stoma disparities after 1 year.
  • Published In

    Digital Object Identifier (doi)

    Author List

  • Gunnells DJ; Wood LN; Goss L; Morris MS; Kennedy GD; Cannon JA; Chu DI
  • Start Page

  • 250
  • End Page

  • 258
  • Volume

  • 22
  • Issue

  • 2