| Title |
Prophylactic mesh reinforcement of stomas: a cost-effectiveness meta-analysis of randomised controlled trials
|
|---|---|
| Published in |
Techniques in Coloproctology, May 2018
|
| DOI | 10.1007/s10151-018-1774-5 |
| Pubmed ID | |
| Authors |
J. M. Findlay, C. P. J. Wood, C. Cunningham |
| Abstract |
Previous meta-analyses of randomised controlled trials (RCTs) have suggested a reduction in parastomal hernias (PSH) with prophylactic mesh. However, concerns persist regarding variably supportive evidence and cost. We performed an updated systematic review and meta-analysis to inform a novel cost-effectiveness analysis. The PubMed, EMBASE and Cochrane Centre Register of Controlled Trials databases were searched (February 2018). We included RCTs assessing mesh reinforcement during stoma formation. We assessed PSH rates, subsequent repair, complications and operative time. Odds ratios (OR) and numbers needed to treat (NNT) were generated on intention to treat (ITT) and per protocol (PP) bases. These then informed cost analysis using 2017 UK/USA reimbursement rates and stoma care costs. Eleven RCTs were included. Four hundred fifty-three patients were randomised to mesh (PP 412), with 454 controls (PP 413). Six studies used synthetic meshes, three composite and two biological (91.7% colostomies; 3.64% ileostomies, 4.63% not specified). Reductions were seen in the number of hernias detected clinically and on computed tomography scan. For the former, ITT OR was 0.23 (95% confidence interval 0.11-0.51; p = 0.0003; n = 11); NNT 4.17 (2.56-10.0), with fewer subsequent repairs: OR 0.29 (0.13-0.64; p = 0.002; n = 7; NNT16.7 (10.0-33.3). Reductions persisted for synthetic and composite meshes. Operative time was similar, with zero incidence of mesh infection/fistulation, and fewer peristomal complications. Synthetic mesh demonstrated a favourable cost profile, with composite approximately cost neutral, and biological incurring net costs. Reinforcing elective stomas with mesh (primarily synthetic) reduces subsequent PSH rates, complications, repairs and saves money. We recommend that future RCTs compare mesh subtypes, techniques, and applicability to emergency stomas. |
X Demographics
The data shown below were collected from the profiles of 20 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 4 | 20% |
| United Kingdom | 3 | 15% |
| Greece | 1 | 5% |
| United States | 1 | 5% |
| Mexico | 1 | 5% |
| Italy | 1 | 5% |
| Unknown | 9 | 45% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 11 | 55% |
| Practitioners (doctors, other healthcare professionals) | 4 | 20% |
| Science communicators (journalists, bloggers, editors) | 4 | 20% |
| Scientists | 1 | 5% |
Mendeley readers
The data shown below were compiled from readership statistics for 40 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 40 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 5 | 13% |
| Other | 4 | 10% |
| Researcher | 4 | 10% |
| Student > Doctoral Student | 2 | 5% |
| Student > Postgraduate | 2 | 5% |
| Other | 6 | 15% |
| Unknown | 17 | 43% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 14 | 35% |
| Nursing and Health Professions | 2 | 5% |
| Unspecified | 1 | 3% |
| Environmental Science | 1 | 3% |
| Chemical Engineering | 1 | 3% |
| Other | 3 | 8% |
| Unknown | 18 | 45% |
Attention Score in Context
This research output has an Altmetric Attention Score of 11. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 31 May 2018.
All research outputs
#3,231,961
of 24,615,420 outputs
Outputs from Techniques in Coloproctology
#355
of 1,333 outputs
Outputs of similar age
#63,778
of 333,132 outputs
Outputs of similar age from Techniques in Coloproctology
#17
of 25 outputs
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