Health costs of post‐operative complications following rectal resection: a systematic review

Abstract

BackgroundPost‐operative complications following rectal resection pose significant health and cost implications for patients and health providers. The objective of this study is to review the associated cost of complications following rectal resection. This included reporting on the proportion and severity of these complications, associated length of stay and surgical technique used. Studies were sourced from Embase OVID, MEDLINE OVID (ALL) and Cochrane Library databases by utilizing a search strategy.MethodsThis search contained studies from 1 January 2010 until 13 February 2019. Studies were included from the year 2010 to account for the implementation of enhanced recovery after surgery protocols. Studies that reported the financial cost associated with complications were included. Any indication for rectal resection was considered. Data was extracted into a formatted table and a narrative synthesis was performed.ResultsWe identified 13 eligible studies for inclusion. There was strong evidence to suggest that complications are associated with increased costs. There was considerable variation as to the costs attributable to complications ($1443 (P < 0.001) to $17 831 (P < 0.0012), n = 12). The presence of complications was associated with an increased length of stay (5.54 (P‐value not given) to 21.04 (P < 0.0001) days, n = 7). There was significant variation in the proportion of complications (6.41 to 64.71%, n = 8). Weak evidence existed around surgical technique used and the associated cost of complications. There was considerable heterogeneity among included studies.ConclusionsComplications following rectal resection increased health costs. Costs should be standardized and provide a clear methodology for their calculation. Complications should be standardized and include a grading of severity.

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

“…There is a higher risk of medical and surgical postoperative complications, especially severe ones, in this subgroup of patients than in the general population [ 21 – 28 ]. The incidence of these complications ranges from 6% [ 29 , 30 ] to over 65% [ 29 , 31 ].…”

“…C. Frail elderly patients who underwent colorectal resection for cancer have a more prolonged hospital stay [ 21 , 22 ], which ranges from 5 days [ 29 , 32 ] to more than 20 days [ 29 , 33 ].…”

“…The increment ranges from 1.500 USD to 18.000 USD [ 29 , 33 ]. Length of hospital stay, obviously influenced by complications, is the first condition that causes an increment of costs [ 29 , 30 , 33 – 36 ]. There is less correlation between healthcare costs and the different surgical techniques [ 29 ].…”

“…Length of hospital stay, obviously influenced by complications, is the first condition that causes an increment of costs [ 29 , 30 , 33 – 36 ]. There is less correlation between healthcare costs and the different surgical techniques [ 29 ]. Currently, a standardized approach for reporting costs associated with complications is lacking.…”

The Hidden Pandemic: the Cost of Postoperative Complications

“…A similar New Zealand study also found a doubling of costs with complications, but a less marked association with complication severity [ 38 ]. Systematic reviews for liver and rectal surgery also support this relationship between cost and complications, and cost and complication severity, but considerable study heterogeneity, and presumably the contextual nature of cost, limits the financial conclusions which can been drawn [ 39 , 40 ].…”