Outcomes and Cost of Diverted Versus Undiverted Restorative Proctocolectomy

Anne M. Stey, Robert H. Brook, Emmett Keeler, Michael T. Harris, Tomas Heimann, Randolph M. Steinhagen

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Some observational studies suggest that diversion during restorative proctocolectomy mitigates the risk of anastomotic complications. However, diversion has its own costs and complications. The aim of this study was to compare the cost and outcomes of diverted to undiverted restorative proctocolectomy. Methods: This study took advantage of a natural experiment within one surgical department to understand the clinical and financial implications of diversion during restorative proctocolectomy. For the last 10 years, two surgeons routinely diverted all patients undergoing restorative proctocolectomy, and two other surgeons routinely did not. The medical records of 288 consecutive restorative proctocolectomy patients were reviewed. Minimum follow-up time was 1 year, with an average of 4.7 years. Complications rates and costs of care were collected. Results: There were no significant differences between rates of anastomotic leak, fistula, or hernias in diverted versus undiverted patients. The odds of having stricture (odds ratio (OR) = 17.08, P < 0.001) and small bowel obstruction (OR = 5.05, P = 0.02) were both significantly higher in diverted patients. The average cost per patient was $43,000 more in the routinely diverted patients. Conclusion: Undiverted restorative proctocolectomy may be the highest value procedure with the most favorable outcomes at the lowest cost.

Original languageEnglish
Pages (from-to)995-1002
Number of pages8
JournalJournal of Gastrointestinal Surgery
Issue number5
StatePublished - May 2014


  • Cost
  • Restorative proctocolectomy


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