Financial Impact of Anastomotic Leakage in Colorectal Surgery

Regina, Davide La; Giuseppe, Matteo Di; Lucchelli, Massimo; Saporito, Andrea; Boni, Luigi; Efthymiou, Christopher Andrew; Cafarotti, Stefano; Marengo, Michele; Mongelli, Francesco

doi:10.1007/s11605-018-3954-z

Cited by 55 publications

(50 citation statements)

References 12 publications

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“…Colorectal anastomotic leakage remains a serious complication with implications on hospital stay, oncological outcomes [1] and treatment cost [2]. Traditional intra‐operative visual perfusion assessment has been shown to be suboptimal [3] and surgeons are looking to indocyanine green (ICG) fluorescence angiography as an adjunct to clinical judgement.…”

mentioning

confidence: 99%

Challenges in the interpretation of colorectal indocyanine green fluorescence angiography – A video vignette

et al. 2021

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mentioning

confidence: 99%

Challenges in the interpretation of colorectal indocyanine green fluorescence angiography – A video vignette

et al. 2021

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“…The above-mentioned rationale is expected to help in reducing OT, which is independent risk factor for adverse outcomes in a wide range of surgical procedures, including laparoscopic Roux-en-Y gastric bypass 24 - 26 . In addition, in the presence of increasing financial pressure, surgeons are today expected to contain their OT while ensuring a low complication rate 27 . In our study cohort, 2D and 3D groups resulted to be similar in terms of demographics, clinical characteristics and complications.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomoses for morbid obesity. A single center experience

et al. 2020

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To assess the impact of three-dimensional (3D) vision use on operative time (OT) in laparoscopic Roux-en-Y gastric bypass (LRYGB) with hand-sewn anastomoses. Methods: We analyzed a prospectively collected database of patients who underwent LRYGB. We included all patients operated on with either 2D or 3D vision. Demographics and clinical characteristics, operative time, hospital stay and 30-day postoperative complications were collected for all patients and analyzed. Results: During the study time, out of 143 patients who underwent LRYGB for morbid obesity, 111 were considered eligible. Seventy-eight patients were operated with 2D vision and 33 patients with 3D vision. Demographics and clinical characteristics were not different among groups. Mean OT was 203±51 and 167±32 minutes in the 2D and 3D groups respectively (p<0.001). Multivariate analyses showed that increasing age and BMI were independently related to prolonged OT, while 3D vision (OR 6.675, 95% CI 2.380-24.752, p<0.001) was strongly associated with shorter OT. Conclusions: The use of 3D vision in LRYGB significantly reduced the OT, though intra-and postoperative complication rates and the length of hospital stay were not affected. Despite its limitations, our study supports the value of 3D vision laparoscopy in bariatric surgery.

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“…Indirect costs were those not directly accountable to patients but that had to be estimated and they were either variable or fixed. Such variable costs are calculated according to diagnostic (ICD-10) 13 and intervention codes (CHOP; Swiss operation classification) 14 for operating theatre, anesthesia, radiology, laboratory, physician salaries and hospital stay. The CHOP and ICD-10 codes are registered during the hospital stay according to diagnostics, interventions and procedures that patients undergo.…”

Section: Cost Calculation and Modelingmentioning

confidence: 99%

Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial

Mongelli¹,

Lucchelli²,

Regina³

et al. 2021

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Background Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to perform a cost analysis on PNB use in in- and outpatients undergoing open hemorrhoidectomy. Methods From January 2018 to December 2019, patients undergoing open hemorrhoidectomy were included and randomized to undergo spinal anesthesia either with or without the PNB. Clinical data, direct and indirect costs for in- and outpatients, operating time and operating theatre occupancy were recorded. A cost-effectiveness analysis based on the diagnosis-related groups (DRG) and TARMED reimbursement systems was performed. Results Patients who underwent PNB in addition to spinal anesthesia had significantly less pain and a shorter length of hospital stay after open hemorrhoidectomy. The cost analysis included all 49 patients, 23 of whom, in addition to spinal anesthesia, received a PNB. There were no significant differences in operating theatre occupancy (p=0.662), mean operative time (p=0.610) or time required for anesthesia (p=0.124). Direct costs were comparable (482±386 vs 613±543 EUR, p=0.108), while indirect costs were significantly lower in the PNB group (2606±816 vs 2769±1506 EUR, p=0.005). We estimated an incremental cost-effectiveness ratio (ICER) of −243 ± 881 EUR/pain unit on the VAS. Conclusion Despite limitations, the ultrasound-guided PNB seems to reduce costs in patient undergoing open hemorrhoidectomy under spinal anesthesia. It was shown to be clinically beneficial and cost-effective, and therefore recommendable in patients undergoing open hemorrhoidectomy.

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Financial Impact of Anastomotic Leakage in Colorectal Surgery

Abstract: 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.

Cited by 55 publications

References 12 publications

Challenges in the interpretation of colorectal indocyanine green fluorescence angiography – A video vignette

Challenges in the interpretation of colorectal indocyanine green fluorescence angiography – A video vignette

Three-dimensional laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomoses for morbid obesity. A single center experience

Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial

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