SRS162 - Ileostomy creation for rectal cancer in England: an observational study of variation, and correlates using administrative data

Abstract Background The presence of a temporary ileostomy following anterior resection substantially impacts quality of life of patients. The study aimed to explore associated factors, trends and variation in ileostomy creation with anterior resection for rectal cancer across England. Methods This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics (HES) dataset for England. All patients aged ≥ 17 years undergoing a planned anterior resection with ileostomy creation between 1st April 2016 and 30th September 2024 were identified. The primary outcome of interest was ileostomy creation at the time of index surgery. Results Of 17 540 anterior resections for rectal cancer over the 8-year study period, 5954 patients (33.9%) had a diverting ileostomy. Ileostomy creation was associated with being male, higher surgeons and trusts annual volume of surgery and having an open or robot-assisted operation. Laparoscopic resections are most frequently performed, however robot-assisted resections have risen over 10-fold during the study period. Ileostomy creation rates have fallen nearly 10% accompanied by a modest reduction in length of stay, but no substantial change in complication rates, anastomotic leaks or readmission rates. There is significant variation in ileostomy creation rates across NHS trusts in England, varying from 5.8 to 62.5%. Conclusions The substantial variation in ileostomy creation rates across England may indicate the need for standardized guidelines for ileostomy creation when treating rectal cancer. It is not clear why ileostomy creation rates have fallen over time, but the lack of a clear association of this change with complications is reassuring.