Ileostomy creation for rectal cancer in England: An observational study of variation, and correlates using administrative data.

Abstract

The decision to create an ileostomy following anterior resection is a clinical one based on the judgement of the surgical team. However, there are few data to support decision-making. This study aimed to explore variation in, and factors associated with, ileostomy creation rates following surgery for rectal cancer in England. This exploratory, retrospective analysis used observational data from England's Hospital Episode Statistics (HES) dataset. All patients aged ≥17 years undergoing an elective anterior resection with ileostomy creation from 1 April 2016 to 31 March 2024 were included. The primary outcome of interest was ileostomy creation at the time of index surgery. In total, 17,540 anterior resections for rectal cancer were included, and 5,954 patients (33.9%) had a diverting ileostomy. Rates of ileostomy creation declined over time, from 38.6% in 2016/17 to 29.7% in 2023/24, while the number of anterior resections remained relatively stable, other than during the COVID-19 pandemic. There was substantial variation in ileostomy creation rates across hospital trusts from 5.8% to 62.5%. Greater odds of ileostomy creation were associated with younger age, male sex, mild/moderate frailty, living in a less deprived area, Asian ethnicity, higher surgeon and trust volume and earlier time periods. Rates of ileostomy creation are falling, but there is huge variation in creation rates across providers and patient groups. Standardised guides on when to create an ileostomy may help reduce the extent of this variation.