The economic impact of anastomotic leak after colorectal cancer surgery

Abstract

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.

Prophylactic defunctioning stomas improve clinical outcomes of anastomotic leak following rectal cancer resections: An analysis of the US Rectal Cancer Consortium

“…The anastomotic leak in this study of 4.66% is lower than that reported in other large studies which range between 10 and 20% depending on the length of follow-up [ 3 , 23 ]. However, it is worth noting that some recent database studies have reported similar leak rates in the range of 3–8% [ 24 , 25 ]. One potential reason for this lower leak rate and limitation of our study is the inability to classify perianastomotic abscesses without signs of active leak as AL in our analysis.…”

Incidence of anastomotic leakage using powered circular staplers versus manual circular staplers for left colorectal anastomosis: a cost-effectiveness analysis

“…The average DRG reimbursement for patients with AL covered only 86% of hospitalization costs, resulting in an average loss per patient with AL of €2041 [ 7 ]. In Spain, a recent study estimated the additional cost of diagnosing and treating AL following colorectal cancer surgery to be €38,819 for patients with colon cancer and €32,599 for patients with rectal cancer [ 26 ].…”

Successful Clinical Avoidance of Colorectal Anastomotic Leakage through Local Decontamination

“…Some bookkeepers-from a patient's point of view-also take increasing costs into consideration and perform an "economic evaluation from a societal perspective as a costeffectiveness and cost-utility analysis" [31,32]. Ultimately, and not surprisingly, number crunchers recently presented "the first cost-analysis study of AL after colorectal surgery" [63] in colorful pictures, and "concluded" that "the appearance of AL generates a considerable increase in the consumption of health resources, mainly due to an increase in hospital stays" and "the more complex the AL, the higher the cost associated with its treatment"-cost analyses on this topic have already been completed and are therefore obviously not an aim of our investigation.…”