In-hospital economic burden of anastomotic leakage after colorectal anastomosis surgery: a real-world cost analysis in Italy

Capolupo, Gabriella Teresa; Galvain, Thibaut; Paragò, V.; Tong, C.; Mascianà, Gianluca; Berardino, Stefano Di; Caputo, Damiano; Vaccara, Vincenzo La; Caricato, Marco

doi:10.1080/14737167.2022.1986389

Cited by 10 publications

(14 citation statements)

References 23 publications

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“…Regardless of the type of neoplasm (CC or RC) and type of AL (A, B or C), the hospital stay (inpatient stay, ICU and emergency room visits) represents the single greatest expense in the diagnosis and treatment of AL, a conclusion similar to that of other studies [ 25 ]. In patients with RC who have type A AL, the overall cost is mainly due to the prolonged hospital stay.…”

Section: Discussionsupporting

confidence: 66%

“…Despite the high incidence of CRC and the high rates of AL, the literature on the economic burden generated by this complication is scarce and focuses on the costs related to the surgical interventions [ 23 ], short hospital stays [ 23 , 24 ], or patients not exclusively oncological [ 23 – 25 ]. This lack of evidence highlights the need to provide surgeons and medical facility managers with useful data to become aware of the clinical and economic magnitude of the problem and to take action to prevent AL.…”

Section: Discussionmentioning

confidence: 99%

“…In a 2021 retrospective, single-centre observational study, Capolupo et al [ 25 ] examined the data of 317 patients who underwent a colon or rectal resection with anastomosis, not necessarily because of a colorectal neoplasia. The incidence rate of AL was 12.3%, 5.9% (14/237) in patients with colon resection and 31.3% (25/80) in patients with rectal resection, much higher than the 8.2% reported by our study (8.7% CC and 7.0% RC).…”

Section: Discussionmentioning

confidence: 99%

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The economic impact of anastomotic leak after colorectal cancer surgery

et al. 2023

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Objective To determine the economic impact of the incremental consumption of resources for the diagnosis and treatment of anastomotic leak (AL) in patients after resection with anastomosis for colorectal cancer compared to patients without AL on the Spanish health system. Method This study included a literature review with parameters validated by experts and the development of a cost analysis model to estimate the incremental resource consumption of patients with AL versus those without. The patients were divided into three groups: 1) colon cancer (CC) with resection, anastomosis and AL; 2) rectal cancer (RC) with resection, anastomosis without protective stoma and AL; and 3) RC with resection, anastomosis with protective stoma and AL. Results The average total incremental cost per patient was €38,819 and €32,599 for CC and RC, respectively. The cost of AL diagnosis per patient was €1018 (CC) and €1030 (RC). The cost of AL treatment per patient in Group 1 ranged from €13,753 (type B) to €44,985 (type C + stoma), that in Group 2 ranged from €7348 (type A) to €44,398 (type C + stoma), and that in Group 3 ranged from €6197 (type A) to €34,414 (type C). Hospital stays represented the highest cost for all groups. In RC, protective stoma was found to minimize the economic consequences of AL. Conclusions The appearance of AL generates a considerable increase in the consumption of health resources, mainly due to an increase in hospital stays. The more complex the AL, the higher the cost associated with its treatment. Interest of the study it is the first cost-analysis study of AL after CR surgery based on prospective, observational and multicenter studies, with a clear, accepted and uniform definition of AL and estimated over a period of 30 days.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The economic impact of anastomotic leak after colorectal cancer surgery

et al. 2023

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“…AL is associated with increased postoperative morbidity, mortality, length of hospital stay, recurrence of cancer, permanent stoma, and total costs (3,14,15). Capolupo et al (16) showed that the cost and length of hospital stay of patients with AL was approximately twice of that of patients without AL. To prevent AL, several strategies have been proposed, but the effectiveness of most of them are still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Capolupo et al. ( 16 ) showed that the cost and length of hospital stay of patients with AL was approximately twice of that of patients without AL.…”

Section: Discussionmentioning

confidence: 99%

Novel surgical procedure for preventing anastomotic leakage following colorectal cancer surgery: A propensity score matching study

Tang

Zhang

et al. 2022

Front. Oncol.

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Hypoperfusion is the main cause of anastomotic leakage (AL) following colorectal surgery. The conventional method for evaluating anastomotic perfusion is to observe color change and active bleeding of the resection margin of the intestine and the pulsation of mesenteric vessels. However, the accuracy of this method is low, which may be due to insufficient observation time. A novel surgical procedure that separates the mesentery in advance at the intended transection site can delay the observation of anastomotic perfusion, and can potentially detect more anastomotic sites with insufficient vascular supply and reduce the rate of AL. This study aimed to investigate the effects of a novel surgical procedure on AL following sigmoid colon and rectal cancer surgeries. A total of 343 patients who underwent rectal and sigmoid colon cancer surgeries were included in the study. From August 2021 to June 2022, patients with sigmoid colon or rectal cancer underwent a new surgical procedure of pre-division of the mesentery (PDM) at the intended transection site (PDM group). Patients with colorectal cancer who underwent conventional surgical procedures from August 2018 to July 2021 were categorized as the non-PDM group. Symptomatic AL (SAL) within 30 days and other outcomes were retrospectively analyzed using propensity score matching and compared between the two groups. The incidences of SAL were 1.3% and 11.3% in the PDM and non-PDM groups, respectively. PDM significantly reduced the SAL rate in sigmoid colon and rectal cancer surgeries (P = 0.009). The incidence of total postoperative complications (P < 0.05) was significantly lower in the PDM group than that in the non-PDM group. There were no significant differences between the two groups for operative time (P = 0.662), intraoperative blood loss (P = 0.651), intraoperative blood transfusion (P = 0.316), and intensive care rate (P = 1). The length of postoperative hospital stay (P = 0.010) and first exhaust (P = 0.001) and defecation time (P < 0.05) were shorter in the PDM group than in the non-PDM group. PDM can effectively prevent AL, and this procedure can be safely performed in sigmoid colon and rectal cancer surgeries.

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The economic impact of anastomotic leakage after colorectal surgery: a systematic review

Nijssen,

Wienholts,

Postma

et al. 2024

Tech Coloproctol

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Background Anastomotic leakage (AL) remains a burdensome complication following colorectal surgery, with increased morbidity, oncological compromise, and mortality. AL may impose a substantial financial burden on hospitals and society due to extensive resource utilization. Estimated costs associated with AL are important when exploring preventive measures and treatment strategies. The purpose of this study was to systematically review the existing literature on (socio)economic costs associated with AL after colorectal surgery, appraise their quality, compare reported outcomes, and identify knowledge gaps. Methods Health economic evaluations reporting costs related to AL after colorectal surgery were identified through searching multiple online databases until June 2023. Pairs of reviewers independently evaluated the quality using an adapted version of the Consensus on Health Economic Criteria list. Extracted costs were converted to 2022 euros (€) and also adjusted for purchasing power disparities among countries. Results From 1980 unique abstracts, 59 full-text publications were assessed for eligibility, and 17 studies were included in the review. The incremental costs of AL after correcting for purchasing power disparity ranged from €2250 (+39.9%, Romania) to €83,633 (+ 513.1%, Brazil). Incremental costs were mainly driven by hospital (re)admission, intensive care stay, and reinterventions. Only one study estimated the economic societal burden of AL between €1.9 and €6.1 million. Conclusions AL imposes a significant financial burden on hospitals and social care systems. The magnitude of costs varies greatly across countries and data on the societal burden and non-medical costs are scarce. Adherence to international reporting standards is essential to understand international disparities and to externally validate reported cost estimates.

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In-hospital economic burden of anastomotic leakage after colorectal anastomosis surgery: a real-world cost analysis in Italy

Cited by 10 publications

References 23 publications

The economic impact of anastomotic leak after colorectal cancer surgery

The economic impact of anastomotic leak after colorectal cancer surgery

Novel surgical procedure for preventing anastomotic leakage following colorectal cancer surgery: A propensity score matching study

The economic impact of anastomotic leakage after colorectal surgery: a systematic review

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