Abstract
Objectives
Despite being a common side effect of stoma surgery, little is known about the health-related quality-of-life (HRQoL) impact of parastomal hernia (PSH). We studied the association between HRQoL and self-reported PSH using data from the large CIPHER prospective cohort study of patients living with a stoma.
Methods
Over 12 months, HRQoL was captured at up to four time points for 2,341 individuals with stomas using EuroQol-5D-5L (EQ-5D-5L). Applying a repeated measures regression, we analysed the association between HRQoL and the incidence of self-reported PSH in the year following surgery. Using ordinal regressions, we estimated the odds of reporting worse function in each of the five EQ-5D-5L dimensions among those reporting PSH. We estimated the average number of quality-adjusted life days (QALDs) lost in those reporting PSH.
Results
Patients experiencing PSH reported significantly lower EQ-5D-5L scores at 12 months following stoma formation (−0.099 [95%CI: −0.126 to −0.071]), amounting to 22.3 QALDs lost per-person-per year. Patients reporting PSH at 12 months had more problems in all EQ-5D-5L dimensions. In four of five dimensions, patients with PSH had more than double the odds of reporting worse HRQoL levels; the difference was most substantial for pain/discomfort (odds ratio 2.80 [95%CI: 2.17 to 3.62]).
Conclusion
Developing PSH significantly reduces HRQoL across a range of health outcomes, including pain/ discomfort, usual activities, self-care, mobility, and anxiety/depression. Therefore, developing and evaluating surgical techniques to prevent PSH is important to reduce the prevalence of PSH following stoma formation. Estimates of HRQoL presented here can be used in cost-effectiveness studies evaluating such interventions.
Despite being a common side effect of stoma surgery, little is known about the health-related quality-of-life (HRQoL) impact of parastomal hernia (PSH). We studied the association between HRQoL and self-reported PSH using data from the large CIPHER prospective cohort study of patients living with a stoma.
Methods
Over 12 months, HRQoL was captured at up to four time points for 2,341 individuals with stomas using EuroQol-5D-5L (EQ-5D-5L). Applying a repeated measures regression, we analysed the association between HRQoL and the incidence of self-reported PSH in the year following surgery. Using ordinal regressions, we estimated the odds of reporting worse function in each of the five EQ-5D-5L dimensions among those reporting PSH. We estimated the average number of quality-adjusted life days (QALDs) lost in those reporting PSH.
Results
Patients experiencing PSH reported significantly lower EQ-5D-5L scores at 12 months following stoma formation (−0.099 [95%CI: −0.126 to −0.071]), amounting to 22.3 QALDs lost per-person-per year. Patients reporting PSH at 12 months had more problems in all EQ-5D-5L dimensions. In four of five dimensions, patients with PSH had more than double the odds of reporting worse HRQoL levels; the difference was most substantial for pain/discomfort (odds ratio 2.80 [95%CI: 2.17 to 3.62]).
Conclusion
Developing PSH significantly reduces HRQoL across a range of health outcomes, including pain/ discomfort, usual activities, self-care, mobility, and anxiety/depression. Therefore, developing and evaluating surgical techniques to prevent PSH is important to reduce the prevalence of PSH following stoma formation. Estimates of HRQoL presented here can be used in cost-effectiveness studies evaluating such interventions.
| Original language | English |
|---|---|
| Number of pages | 10 |
| Journal | European Journal of Health Economics |
| Early online date | 11 Mar 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 11 Mar 2025 |
Bibliographical note
Publisher Copyright:© The Author(s) 2025.
Research Groups and Themes
- HEHP@Bristol