Article: Aging Disparities in Ostomy Surgery
Year Published: February 2025
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Describe the method used by the author of the study.
ReplyDeleteThe method used in this study was a multi-institutional cohort study that had undergone colorectal resection between the years of 2003-2014. Patients were selected based on the interpretation of a Healthcare inpatient administrative database, representing a 20% sample size of all US based hospitals. The method compared research across the database to make selection of the sample size for comparable data. There were specific patients excluded including those under the age of 18 and patients who underwent both a procedure of colostomy and ileostomy formation.
Discuss the research question or main problem discussed in the study?
This study focuses on two different problems related to fecal ostomy surgery, the development of a potential permanent ostomy and patient outcomes. The first problem of focus in the study is the rate of which fecal ostomy operations are performed for patients who undergo colorectal resection due to severe bowel symptoms, intestinal obstruction, avoidance of pelvic infections or reducing symptoms of incontinence. The second problem of focus is to compare the rates of colostomy formation between groups of patients younger and older than age 65; to see the overall impact of quality of life after colostomy formation.
1. Discuss the limitations of the article: limited sample size, design flaws and/or author bias?
ReplyDeleteOne limitation of the article is that the database they used does not include the clinical decision making that led to ostomy formation, such as presence of tissue or tension when attempting to create the anastomosis which can obscure the clinical context and rationale behind the procedure.
The authors also did not include the operations with ostomy formation without a colorectal resection which underestimate the overall number of patients living with ostomy.
Finally, the database used by the authors did not provide longitudinal data and the authors were unable to evaluate hospital readmissions or rates of ostomy reversals.
2. Discuss the method used by the author of the study?
The method used by the author is a multi-institutional cohort study of patients undergoing colo-rectal resection from 2003 to 2014. Identified data were obtained from the Nationwide Inpatient
Sample Database.
The data set contains hospital and patient specific information in a representative sample. Hospital records from approximately 1000 hospitals across the U.S. which represents the 20% sample of
the hospital until 2012 was used.
Patients included in this study had a hospital admission during which a colo-rectal resection with or without was performed. Patients younger than 18 years old were excluded.
Discuss the research question or main problem discussed in the study.
ReplyDeleteThis study identified two primary research goals. The first was to answer whether age influences the rate and type of fecal ostomy formation in patients undergoing colorectal resection. The second question was how these rates have changed over time in the United States. The study focused on identifying differences between patients under and over 65 years of age, with the goal of understanding surgical trends and informing strategies to improve patient-centered care, especially for older adults.
Discuss the sample size used in the study.
The study evaluated 819,441 adult patients who underwent colorectal resection between 2003 and 2014. Among these, 16.6% of patients received an ostomy, with 10.0% undergoing colostomy and 6.6% undergoing ileostomy. The ostomy cohort consisted of 73,436 patients under 65 years old and 63,404 patients aged 65 years and older, providing a large sample size for identifying statistically significant differences and trends.
1) Describe the method used by the author of the study.
ReplyDeleteThe method used in this study is multi institutional cohort study of patients undergoing colorectal resection from 2003-2014. The data were obtained from the Nationwide Inpatient Sample database. NIS weas created as part of the Agency for healthcare research and quality healthcare research cost snd utilization project and is the largest all payer nationwide inpatient administration database. It contains hospital records from approximately 1000 hospitals across the USA.
2)Discuss the limitations of the article
The database is based on billing codes that have been described as inaccurate in previous studies because they might be entered by non medically trained personnel. One significant limitation is that the database dose not include the clinical decision making that led to ostomy formation, such as presence of friable tissue or tension when attempting to create the anastomosis.
1. Describe the method used by the author of the study.
ReplyDelete- The method used in this study was a multi-institutional cohort study that had undergone colorectal resection between the years of 2003-2014. Patients were selected based on the interpretation of a Healthcare inpatient administrative database, representing a 20% sample size of all US based hospitals. NIS was created as part of the Agency for healthcare research and quality healthcare research cost and utilization project and is the largest all payer nationwide inpatient administration database.
2. Discuss the research question or main problem discussed in the study.
- the study addressed two main issues. the first was to answer whether age is an influence in rate and type of fecal ostomy formation in colorectal resection procedures. the second was how rates have changes over time in the US. The study focused on identifying differences between patients under and over 65 years of age, with the goal of understanding surgical trends and informing strategies to improve patient-centered care, especially for older adults.
1. Discuss the research question or main problem discussed in the study.
ReplyDeleteThis study examines two key issues in fecal ostomy surgery: the potential development of permanent ostomies and patient outcomes. It explores the frequency of fecal ostomy operations in patients undergoing colorectal resection due to severe bowel symptoms, intestinal obstruction, prevention of pelvic infections, or incontinence symptom relief. The study also compares colostomy formation rates between patients below and above 65 years old, aiming to assess impacts on quality of life. The research primarily investigates whether age affects the rate and type of fecal ostomy formation and how these trends have evolved in the United States. The findings aim to inform strategies for enhancing patient-centered care, particularly for older adults.
Describe the method used by the author of the study.
This study employed a multi-institutional cohort approach to analyze patients who underwent colorectal resection from 2003 to 2014. Researchers utilized a healthcare inpatient administrative database, representing a 20% sample of all U.S. hospitals, to select participants. The method involved comparing data across the database to choose the sample size for comparative analysis. Patients under 18 and those who had both colostomy and ileostomy procedures were excluded from the study.
ReplyDeleteDescribe the method used by the author of the study.
This study conducted research based on patients who had colorectal surgery from 2003 to 2014. A large sample, utilizing 20% of hospitals from the Nationwide Inpatient Sample Database in the United States was where the participants were selected. Comparisons were made between different cases which were then used to guide for sample size and further analyzation. Criteria exclusion was to individuals under 18 who had colostomy and ileostomy procedures.
1.What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteThe article examines differences in ostomy surgeries between patients aged 65 and older and younger adults, highlighting disparities in care. Using a retrospective cohort study with data from the National Inpatient Sample, the study identifies trends and inequities in surgical decision-making. Findings emphasize the need for equitable care, improved outcomes, and policy adjustments, though implementation may require staff training and resources. Limitations include the retrospective design, reliance on administrative data, and potential confounding factors. Overall, the study provides valuable insights for addressing age-related disparities in surgical care.
2.Discuss the research question or main problem discussed in the study?
The main problem addressed in the study “Aging Disparities in Ostomy Surgery” is the potential inequity in surgical care for older adults compared to younger patients. The research focuses on identifying whether patients aged 65 and older receive fecal ostomy operations at different rates than younger adults and explores the factors contributing to these disparities. The study aims to answer questions such as: Are older adults less likely to receive necessary ostomy surgeries? What trends exist in surgical decision-making across age groups? By addressing these questions, the study seeks to highlight age-related disparities in surgical practice and provide insights for improving equitable access to care for older patients.
Discuss the sample size used in the study.
ReplyDeleteThe sample size for this study was a total of 819,441 adults that were over the age of 18 and underwent a colorectal resection between the years of 2003 and 2014. Out of the patients that had a resection, it was found that 136,840 of those patients’ procedure results in an ostomy formation, 82,606 of patients (10.2%) underwent a colostomy, and 54,234 patients (6.6%) had an ileostomy. Overall, 73,436 patients who underwent an ostomy were under sixty-five and 63,404 patients were sixty-five or older. This data showed there was a decline in the formation of ostomy after colorectal resection in both groups that were being analyzed.
Discuss the research question or main problem discussed in the study?
This research study aims to compare the rate of colostomy formation between patients sixty-five and older and younger than sixty-five years old. The study is using data collected between 2003 and 2014 for patients that are eighteen years and older that have undergone colorectal resection. Fecal ostomy surgery helps treat a variety of conditions such as colorectal cancer and diverticular disease. This article mentions a study that was previously done showing that older adults that underwent ostomy surgery experienced a decline in quality of life and functional status. From the data that was collected, this study found that ostomy formation occurred in one in six colorectal resections, and concluded that the formation of an ostomy resulting after a colorectal procedure has decline in both groups, although both groups have seen a decline, the rate for ostomy formation in patients 65 and older is greater than in the under sixty-five year old group.
Describe the method used by the author of the study.
ReplyDeleteThe method that was used in the study was a multi-institutional cohort study that involves patients who underwent colorectal resection during 2003 and 2014. Patients were selected from healthcare inpatient healthcare administrative database which represented a 20% sample size of all US-based hospitals. It compared the research across this database to see the sample size for comparable data. Specific exclusion criteria have patients under 18 years of age and those who underwent both colostomy and ileostomy formation procedures.
Discuss the research question or main problem discussed in the study?
The study aims to understand the frequency at which fecal ostomy operations performed following colorectal resection in patients getting severe bowel symptoms, intestinal obstruction and the need to avoid pelvic infections to reduce symptoms of incontinence. It also focuses the comparison of colostomy formation between the younger and older group, to see the impact of quality of life. Tailoring placement is important to help ease in managing in daily routines.
1. Describe the method used by the author of the study:
ReplyDeleteThis study is a retrospective multi-institutional cohort study using patients 18 years old or older who had a colorectal resection between 2003 to 2014 using the Nationwide Inpatient Sample database. The included patients either did or did not have a fecal ostomy formation, and those who did were further subdivided into those with an ileostomy or colostomy. The specific data used contained patient demographics, clinical characteristics as in type of fecal diversion, primary diagnosis and emergent vs. elective, and the year in which the information was collected. A difference-in-difference analysis was used to determine changes in colostomy formation rates over time between different age groups.
2. Discuss the sample size used in the study:
Patients 18 years old and older who had colorectal resection with or without fecal ostomy formation between the years 2003-2014 using the Nationwide Inpatient Sample database were used. 819,441 adult patients underwent this surgery, where 82,606 (10%) patients had colostomy formation and 54,234 (6.6%) had an ileostomy formation. 73,436 patients with an ostomy were younger than 65, and 63,404 patients were 65 years old or older.
1. Describe the method used by the author of the study.
ReplyDeleteThe study employed a retrospective, multi-institutional cohort design to analyze trends in ostomy procedures among adult patients undergoing colorectal resection from 2003 to 2014. Data were sourced from the Nationwide Inpatient Sample database, utilizing International Classification of Diseases, 9th edition Procedural Codes to identify relevant cases.
The primary objective was to assess the rates of colostomy and ileostomy formations over time, specifically comparing trends between patients aged 65 and older and those under 65. A difference-in-difference analysis was conducted to evaluate the changes in colostomy formation rates across these age groups. The study found that while the overall incidence of colostomy formation decreased during the study period, the decline was less pronounced among older adults, suggesting a slower adoption of alternative surgical approaches in this demographic.
This methodology allowed the researchers to quantify and compare temporal changes in surgical practices, providing insights into age-related disparities in ostomy surgery trends.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The article, while informative, has several limitations. First, the study relies on data from the Nationwide Inpatient Sample, which, although large, may not capture all cases of colorectal surgery nationwide, potentially limiting generalizability. Second, as a retrospective cohort study, it is subject to inherent design limitations such as missing data, coding errors, and inability to establish causal relationships. Third, the use of administrative databases may lack detailed clinical information, such as patient comorbidities or surgeon decision-making factors, which could influence outcomes. Finally, there is a potential for author or selection bias, as the study only includes hospitalizations captured in the database and may not reflect community-level practices or patient preferences, which could affect the observed age-related disparities.
1). What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe article’s recommendations emphasize tailoring ostomy care for older adults through improved preoperative counseling, proactive discharge planning, and patient-centered support systems. Advantages include better preparation for patients and families through realistic counseling about discharge expectations, reduced complications by allocating resources such as home health or rehabilitation services, and more personalized care that accounts for vulnerabilities like arthritis, polypharmacy, and cognitive decline. These approaches also align with professional guidelines, reinforcing the importance of structured counseling to improve outcomes and satisfaction. However, disadvantages include the increased demand for hospital resources, the potential strain placed on family caregivers, and the uncertainty of causality since the study cannot prove ostomy formation alone leads to non-home discharge. In addition, the wide variation in older adults’ functional status means that recommendations may not apply equally to all patients, making implementation complex.
2). Discuss the sample size used in the study.
The study included 819,441 adult patients who underwent colorectal resection from 2003–2014, of which 136,840 (16.6%) had an ostomy—82,606 colostomies and 54,234 ileostomies. The large, nationally representative sample strengthens generalizability, though reliance on administrative data limits clinical detail.
1). What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe article recommends tailoring ostomy care for older adults by strengthening preoperative counseling, enhancing discharge planning, and building patient-centered support systems. These strategies can better prepare patients and families through realistic counseling, reduce complications by using resources like home health or rehabilitation services, and provide individualized care for issues such as arthritis, polypharmacy, and cognitive decline, while also aligning with professional guidelines to improve satisfaction and outcomes. However, they also increase the demand for hospital resources, may burden family caregivers, face uncertainty since causality between ostomy formation and non-home discharge is unproven, and can be difficult to implement given the wide variation in older adults’ functional status.
2). Discuss the sample size used in the study.
The study examined 819,441 adult patients who underwent colorectal resection between 2003 and 2014. Among them, 136,840 (16.6%) had an ostomy, with 82,606 colostomies and 54,234 ileostomies. While the large, nationally representative sample supports generalizability, the reliance on administrative data limits the depth of clinical detail.