Financial Impact of Anastomotic Leakage in Colorectal Surgery.

Autor: La Regina D; Department of Surgery, EOC-Ospedale Regionale di Bellinzona e Valli, Ospedale San Giovanni, via Ospedale, Bellinzona, Switzerland., Di Giuseppe M; Department of Surgery, EOC-Ospedale Regionale di Bellinzona e Valli, Ospedale San Giovanni, via Ospedale, Bellinzona, Switzerland., Lucchelli M; Medical Controller, EOC-Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland., Saporito A; Division of Anesthesiology, EOC-Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland., Boni L; Department of Surgery, Fondazione IRCCS, Ospedale Maggiore Policlinico, Milan, Italy., Efthymiou C; Cardiothoracic Surgery, Glenfield Hospital, Groby Road, Leicester, UK., Cafarotti S; Department of Surgery, EOC-Ospedale Regionale di Bellinzona e Valli, Ospedale San Giovanni, via Ospedale, Bellinzona, Switzerland., Marengo M; Department of Surgery, EOC-Ospedale Regionale di Bellinzona e Valli, Ospedale San Giovanni, via Ospedale, Bellinzona, Switzerland., Mongelli F; Department of Surgery, EOC-Ospedale Regionale di Bellinzona e Valli, Ospedale San Giovanni, via Ospedale, Bellinzona, Switzerland. francesco.mongelli@mail.com.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2019 Mar; Vol. 23 (3), pp. 580-586. Date of Electronic Publication: 2018 Sep 13.
DOI: 10.1007/s11605-018-3954-z
Abstrakt: Background: Anastomotic leakage after colorectal surgery is a complication that requires additional treatments strongly affecting the economic outcomes. We evaluated the use of resources and the economic burden associated with anastomotic leaks following colorectal surgery.
Methods: Between January 2015 and December 2016, we retrospectively evaluated patients who underwent colorectal surgery with primary anastomosis. We compared the medical resource utilization and the DRG-based reimbursement of cases with uncomplicated surgery and cases complicated by anastomotic leakage.
Results: Of the 95 patients included in the study, 87 (92%) presented an uneventful postoperative course and 8 patients (8%) developed an anastomotic leakage requiring surgery. The statistical analysis showed no significant differences in terms of demographics, risks factor, and operative results, except the length of hospital stay (9.7 vs. 29.1 days, p < 0.01). The cost for 87 uncomplicated cases was 1,535,297 EUR (average cost of 17,647 EUR), whereas the cost of the 8 patients with anastomotic leakage was 575,822 EUR (average cost of 71,978 EUR) (p < 0.01). For each patient, the hospital had 542 EUR profit in the uncomplicated group and a 12,181 EUR loss in the anastomotic leakage group (p < 0.01). The multiple R-squared line regression analysis showed that factors independently related to costs were age (p = 0.05) and length of hospital stay (p = 0.01).
Conclusions: In terms of economic impact, the occurrence of an anastomotic leakage has a large negative influence on medical resource utilization, so that, despite the complication-related increase of DRG-reimbursement, every complicated case represents a financial burden for the hospital.
Databáze: MEDLINE
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