Accès ouvert déclaré 2024 article

Long-term cost-effectiveness of insertion of a biological mesh during stoma-site closure: 5–8-year follow-up of the ROCSS randomized controlled trial

Mark Monahan, Manjinder Kaur, Tracy Roberts, Lorraine Munetsi, Ellen Jerome, Laura Magill, Ruth Evans, Siobhan Mackay, Mathew Popplewell, Alasdair Ball, Rebecca Griggs, J. Shabbir, Ahmed Ebrahim, T. M. Hammond, Vibha Ramesh, Talakalukoppa Amarnath, Olivia O’Connor, Evripidis Tokidis, Michael Pierson, Peter J. Webster, Tim Wilson, George H. Davis, Mark Doyle, Benjamin Finch, Anuj Gupta, Denise Hill, Michael Popoola, Andrew Rees, Lisa Santos, Benjamin Stubbs, Maddy Taylor, Gakul Bhatta, Christopher Liao, Adeline Rankin, Elva Wilhelmsen, James M. Blackwell, E Lenzi, Nicholas Watson, Jill Cooke, Chloe Hardy, Franscois Runau, James A. Wolff, Farhat Naaz Amir, Phillippa Hill, Chris J Smart, Zoe Gates, Nuha Yassin, R J Holdsworth, Ami Mishra, Mohamed Rabie, Kimberley Netherton, Milind Rao, Adam Walsh, Dibyendu Bandyopadhyay, Christopher Barr, Kay Kell, Agnieszka Tulwin, Lucy Pippard, Samir Mehta, James Glasbey, Sue Jowett, Dion Morton, Thomas Pinkney, Kelly Handley, James Brown, Richard Wilkin, Aneel Bhangu, Amani Asour, Sudhakar Mangam, Austin G. Acheson, James Ng, Jaspreet Seehra, Hersham Elhakim, Angus Watson, Marius Paraoan, Amal Singh, Claire Williams, Rebecca Lefroy, Neil Yeomans, Joyce Katebe, Emily Wales, Julian Zeolla, Graham Branagan, A.D. Shaw, Charles West, Julie Colley, Samerah Saeed, Andrew Torrance, Anthony Antoniou, Manisha Baden, Yolanda Baird, Bruce Levy, Erikka Siddall, Ankita Sunny, Yvette Thirwall, Ester Towner, Manijeh Ghods, Bridget Hopkins, Sharad Karandikar, H. Mann, Arlo Whitehouse, H.A. Willis, Marriam Ahmed, Abhilasha Patel, J Rayer, Nigel Williams, Elizabeth A. Baker, Deborah Wilson, Deborah Nicol, Sarah Duff, Mary Kumarendran, Iona Pearson, Nader Francis

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Résumé fourni par la source

BACKGROUND: The original ROCSS trial demonstrated a significant reduction in clinically detectable incisional hernias at 2 years in patients receiving prophylactic biological mesh during stoma closure. ROCSS-Ex was designed to investigate the 5-8-year cost-effectiveness of mesh in the surviving cohort using an abdominal wall-specific quality of life score. METHODS: Eligible participants from original UK centres were identified. The primary outcome (abdominal wall-specific quality of life) was measured using the HerQLes score and EQ-5D-5L. Assessors remained blind to patients' original allocation, even if the patient was aware of their treatment. RESULTS: Of the original 790 patients, 598 were available for long-term follow-up. HerQLes scores were available for 396 patients (no mesh: 191, mesh: 205). There was no difference in primary outcome between the two groups (mean difference of 1.48, 95% c.i. (-2.35, 5.32), P = 0.45) and no cost benefit of routine insertion of prophylactic biological mesh across the entire cohort in the long term. However, patients who received mesh experienced significantly fewer stoma site complications within the first 3 years after reversal and needed fewer surgical reinterventions (32 versus 54 for the no mesh group; incidence rate ratio of 0.55, 95% c.i. (0.31, 0.97), P = 0.04). CONCLUSIONS: ROCSS-Ex has shown equivocal outcomes for prophylactic mesh insertion versus standard repair on abdominal wall-specific quality of life 5-8 years after surgery. As most reinterventions occurred within the first 3 years post-surgery, there may be a role for prophylactic mesh in a subset of patients who would be most adversely affected by repeated surgery early on. TRIAL REGISTRATION: ISRCTN25584182 (http://www.clinicaltrials.gov).

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DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.

Titre Crossref: Long-term cost-effectiveness of insertion of a biological mesh during stoma-site closure: 5–8-year follow-up of the ROCSS randomized controlled trial
Date Crossref: 01/08/2024
Éditeur: Oxford University Press (OUP)
Type: journal-article

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Institutions déclarées

University of Birmingham

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Sujets associés

Stoma care and complicationsHernia repair and managementSurgical site infection prevention

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