Primary Medical Effects and Economic Impact of Anastomotic Leakage in Patients with Colorectal Cancer. A Middle-Income Country Perspective

Abstract

Introduction: Anastomotic leakage is one of the most serious surgical complications that can increase the potential postoperative morbidity, mortality, and overall costs of patient care. Aim of study: To assess the economic burden of anastomotic leakage and to estimate its major clinical effects on patient evaluation.Materials and methods: We retrospectively reviewed single-surgeon data about patients who underwent surgical intervention for colorectal cancer at the 2nd Surgery Department of the Mureș County Emergency Clinical Hospital between January 2019 and July 2020. We assessed general characteristics, surgical data, postoperative information, oncologic results, and financial aspects for each patient. Depending on the presence of anastomotic leakage, patients were divided into two groups: a study group (SG) – patients with postoperative anastomotic failure, and a control Group (CG) – patients without postoperative anastomotic failure.Results: Patients with anastomotic leakage presented increased use of antibiotics, greater number of surgical reinterventions, longer period of intensive care treatment, prolonged hospitalization, increased overall costs, and significantly greater financial loss for the hospital.Conclusion: Anastomotic leakage leads to important negative effects, including longer hospitalization, prolonged intensive care unit stay, greater incidence of surgical reintervention, increased hospitalization costs, and significant financial loss.

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

“…Anastomotic leakage rates ranged from 4.3% [ 26 ] to 29.8% [ 21 ]. Three studies reported the severity of AL either according to the International Study Group of Rectal Cancer classification Grade A–C [ 28 , 30 ] or to the severity of peritoneal contamination [ 4 ], and 7 out of 17 studies reported the rate of diverting ostomy during index surgery [ 4 , 22 , 24 , 26 , 28 , 29 , 33 ], of which the highest reported rate was by Ashraf et al. [ 4 ] at 37.2% and the lowest rate by la Regina et al.…”

“…These rates after AL ranged from 3.7% to 29.0% (30-day readmission) [ 32 , 34 ] and from 18.5% to 44.0% (90-day readmission) [ 21 , 31 ]. The mortality rate ranged from 3.2% (30 days) to 25% (index admission) [ 4 , 30 ] in all cases with AL and from 0% (index admission) to 11% (index and readmission) [ 32 , 33 ] in patients without AL.…”

“…Conversely, Elthes et al. [ 30 ] (Romania) calculated the lowest incremental costs looking only at index admission costs at 2250€ or a 39.9% increase. Percentage-wise the lowest increase in costs of AL was demonstrated by Bai et al.…”

“…These costs ranged from 7289€ (index admission + 30 days) [ 25 ] to 83,633€ (index admission + 30 days) [ 28 ]. One study encompassed both higher and lower resections for colorectal cancer in their cost estimation of anastomotic leakage, averaging 2250€ solely for the index admission [ 30 ]. The remaining nine studies estimated the costs in an aggregated group consisting of colon and rectal resections for both benign and malignant diseases.…”

“…Elthes et al. [ 30 ] described that the incremental costs for AL in a Romanian cohort of colorectal cancer resections were only 851€ (2250€ after correction for purchasing power disparities with PPP). This figure is an outlier and remarkably lower than the estimation by Ribeiro et al.…”