The impact of parastomal hernia on quality of life using data from the CIPHER prospective cohort study.

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.