Management of penetrating colon trauma: A cost-utility analysis

Background. Management of penetrating colon injuries in the presence of multiple associated risk factors is controversial. Issues not considered in previous management strategies are patient perception of quality of life with a colostomy and the true cost of each therapeutic option, which includes colostomy supplies and costs of colostomy takedown. To evaluate these issues, we performed a cost-utility analysis. Methods. We constructed a decision tree with 3 options: primary repair resection and anastomosis, and colostomy. Chance and decision nodes on each decision branch represent injury severity, complications, colostomy takedown, and death. Chance node frequencies and utility assignments were taken from published data. We obtained actual costs for all components of perioperative care. The outcomes reported are cost and quality of life. Results. Colostomy has the least quality of life and the greatest cost. Primary repair and resection each dominate colostomy in the baseline analysis. No variable significantly altered these conclusions in sensitivity analyses. Conclusions. Simple suture or resection and anastomosis at the time of initial exploration is the dominant management method for penetrating colon trauma. It also demonstrates the trade-off between cost and life expectancy of the 3 management options.