A health-related quality-of-life study comparing Vitala continence control device versus traditional pouch system only in patients with end colostomy

Ostomy continence devices: a systematic review of the literature and meta-analysis

AIM

Colostomy complication rates range widely from 10% to 70%. The psychological burden on patients, leading to lifestyle changes and decreased quality of life (QoL), is one of the largest factors. The aim of this work was to assess the history and efficacy of ostomy continence devices in improving continence and QoL.

METHOD

In this PRISMA-compliant systematic review and meta-analysis, we searched PubMed, Scopus, Google Scholar and clinicaltrials.gov for studies on continence devices for all ostomies up to April 2023. Primary outcomes were continence and improvement in QoL. Secondary outcomes were leakage, patient's device preference and complications. Risk of Bias 2 and the revised tool to assess risk of bias in non-randomized studies of interventions (ROBINS-1) were used to assess risk of bias. Certainty of evidence was graded using GRADE.

RESULTS

Twenty-two studies assessed devices from 1978 to 2022. The two main types identified were ball-valve devices and plug systems. Conseal and Vitala were the two main devices with significant evidence allowing for pooled analyses. Conseal, the only currently marketed device, had a pooled rate of continence of 67.4%, QoL improvement was 74.9%, patient preference over a traditional appliance was 69.1%, leakage was 10.1% and complications was 13.7%. Since 2011, five studies have investigated experimental devices on both human and animal models.

CONCLUSION

Ostomy continence has been a long-standing goal without a consistently reliable solution. We propose that selective and short-term usage of continence devices may lead to improved continence and QoL in ostomy patients. Further research is needed to develop a reliable daily device for ostomy continence. Future investigation should include the needs of ileostomates.

Value-Based Healthcare in Ostomies

In order to achieve significant improvements in quality, cost, and accessibility (the health “iron triangle”), innovation in organizational and service delivery models is necessary to increase the value of healthcare. The aim of this study is to evaluate the efficiency of a model of organizational innovation based on advanced practice nurse in the care of people with ostomies (APN-O) versus usual care. An observational, exploratory, analytical, prospective study with a six-month follow-up was carried out at 12 hospitals that implemented this model in Andalusia. A total of 75 patients who had undergone a digestive elimination ostomy and/or a urinary ostomy were followed for six months. Clinical outcomes, healthcare resources, health-related quality of life, and willingness to pay (WTP) were analyzed. The economic evaluation was conducted from a societal perspective, including healthcare costs and indirect costs. The cost difference between the two models was €136.99 and the quality-adjusted life year (QALY) gained was 0.05965 (€2297 per QALY gained). At six months, the mean of WTP was €69 per APN-O consultation. This model contributes to increasing the value-based healthcare in ostomies. Results of this study suggested that APN-O is an effective patient management model for improving their health status and is highly efficient.

Innovative appliance for colostomy patients: an interventional prospective pilot study

Background

The control of body waste emptying is a constant research topic in stoma care. The aim of this pilot study was to assess the efficacy and safety of an innovative colostomy appliance.

Methods

An interventional prospective non-comparative pilot study was conducted in seven French centers. The study device is a new type of two-piece appliance including a base plate and a “capsule cap” (CC) composed of a capsule cover and a folded collecting bag. The device gently seals the stoma to provide stoma output control. When the bowel movement pressure increases the patient may control the deployment of the folded bag and collect stools. Patients with left-sided colostomy all using a flat appliance, were enrolled in a 2-week trial. Outcome measures were type of CC removal and peristomal fecal leaks while wearing the device.

Results

Of 30 patients (females 66.7%), with left-sided colostomy (permanent 76.7%), 23 (76.7%) completed the 2-week trial. A total of 472 CC changes were analyzed. Efficacy: of 404 (85.5%) CC changes reported in diaries, 302 (74.8%) were linked with stool and/or gas. In 244 (60.3%) changes, the patient controlled stoma bag deployment and it occurred with bowel emptying 301 (74.5%) times. No leaks around the appliance were observed in 400 (85.3%) changes. Safety: no serious adverse event occurred. Peristomal skin was not modified during the trial.

Conclusions

In the short term this new device has provided an increased control over bowel emptying at no risk in half of the trial population suggesting that an alternative approach to bag wearing is achievable.

Health State Utility Values for Ileostomies and Colostomies: a Systematic Review and Meta-Analysis

BACKGROUND

Ileostomies and colostomies may affect the quality of life of patients after colorectal surgery; however, the impact has been difficult to quantify using questionnaire-based measures. Utilities reflect patient preferences for health states and provide an alternate method of quality of life assessment. We aimed to systematically review the literature on utilities for ileostomy and colostomy health states.

METHODS

We searched MEDLINE, EMBASE, and EBM Reviews (to August 16, 2017) to identify studies reporting utilities for colostomies or ileostomies using direct or indirect, preference-based elicitation tools. We categorized utilities based on elicitation group (patients with stoma, patients without stoma, healthcare providers, general population) and tool. We pooled utilities using random effects models to determine mean utilities for each elicitation group and tool.

RESULTS

We identified ten studies reporting colostomy utilities and three studies reporting ileostomy utilities. Utilities were most commonly obtained using direct elicitation measures administered to individuals with an understanding of the health state. Patients with stomas and providers gave high utility ratings for the colostomy state (range 0.88-0.92 and 0.86-0.92, respectively, using direct elicitation tools). Ileostomy utilities obtained from patients following surgery and from providers also demonstrated high values placed on the ileostomy health state (range 0.88-1.0).

CONCLUSIONS

Following stoma surgery, values placed on quality of life are similar to those obtained from patients with conditions such as asthma and allergies or individuals of similar age without chronic conditions. This confirms the findings of questionnaire-based studies, which report minimal long-term decrements to overall quality of life among stomates.

The impact of specialty practice nursing care on health-related quality of life in persons with ostomies

PURPOSE

Ostomy patients suffer significant physiological challenges that can affect psychological variables and health-related quality of life (HRQOL). The purpose of this study was to compare HRQOL in a group of patients cared for in hospitals that employed nurses specializing in ostomy care versus patients who were cared for at hospitals that did not employ nurses specializing in ostomy care.

DESIGN

Multicenter, quasi-experimental, prospective, longitudinal study.

SUBJECTS AND SETTING

This is a national study set in Spain. We collected data from 402 ostomy patients in health centers among 16 Spanish regions from March 2012 to June 2013. The average age of the patients was 61.3 ± 13.71 years (mean ± SD).

METHODS

Questionnaires were administered by the investigators prior to and 3 months after the ostomy surgery. Two groups of patients were compared: patients in group 1 were treated by nurses specializing in ostomies; patients in group 2 were not treated by an ostomy nurse specialist. Two validated scales were used to determine HRQOL: EQ-5 D (Spanish version) and the Montreux questionnaire.

RESULTS

Patients in group 1 adapted better to their ostomies than group 2. They exhibited less concern with appearance; increased comfort with cleaning, changing, and throwing away ostomy bags; and decreased pain and pain frequency. They reported less fearfulness; improvements in sleep, weight concerns, and strength; and better overall health, leading to a greater percentage of patients able to lead a normal life (P < .05). Sexual activity was the only variable that worsened in both groups, but it was more satisfactory at postoperation stage in group 1 (P = .015).

CONCLUSIONS

Patients who received specialized ostomy care experienced significant improvements in HRQOL compared to patients who were not cared for by specialist nurses. Our findings strongly suggest that patients undergoing ostomy surgery should be provided access to a nurse specialist in ostomy care since our results highlight the potential benefit promoting the HRQOL of patients.