The Burden of Gastrointestinal Anastomotic Leaks: an Evaluation of Clinical and Economic Outcomes

Abstract

ObjectiveTo evaluate the clinical and economic burden associated with anastomotic leaks following colorectal surgery.MethodsRetrospective data (January 2008 to December 2010) were analyzed from patients who had colorectal surgery with and without postoperative leaks, using the Premier Perspective™ database. Data on in-hospital mortality, length of stay (LOS), re-admissions, postoperative infection, and costs were analyzed using univariate and multivariate analyses, and the propensity score matching (PSM) and generalized linear models (GLM).ResultsOf the patients, 6,174 (6.18 %) had anastomotic leaks within 30 days after colorectal surgery. Patients with leaks had 1.3 times higher 30-day re-admission rates and 0.8–1.9 times higher postoperative infection rates as compared with patients without leaks (P < 0.001 for both). Anastomotic leaks incurred additional LOS and hospital costs of 7.3 days and $24,129, respectively, only within the first hospitalization. Per 1,000 patients undergoing colorectal surgery, the economic burden associated with anastomotic leaks—including hospitalization and re-admission—was established as 9,500 days in prolonged LOS and $28.6 million in additional costs. Similar results were obtained from both the PSM and GLM for assessing total costs for hospitalization and re-admission.ConclusionsAnastomotic leaks in colorectal surgery increase the total clinical and economic burden by a factor of 0.6–1.9 for a 30-day re-admission, postoperative infection, LOS, and hospital costs.

A novel powered circular stapler designed for creating secure anastomoses

“…Post-operative anastomotic leaks occur in up to 1%-4% of gastrectomies [13,14], 8%-11% of esophagectomies [15,16], and 6%-14% of colorectal resections, with mortality in the latter reported between 2% and 12% [17][18][19][20]. Post-operative anastomotic leak may result in 65%-81% higher total hospital costs and 56%-100% longer length of hospital stay [19,20]. Patients who had post-operative anastomotic leaks incurred an additional hospital cost of $28,600 [19].…”

“…Post-operative anastomotic leak may result in 65%-81% higher total hospital costs and 56%-100% longer length of hospital stay [19,20]. Patients who had post-operative anastomotic leaks incurred an additional hospital cost of $28,600 [19].…”

The Incidence and Mortality of Anastomotic Leakage after Colorectal Cancer Surgery

“…Its incidence ranges from 1.5% to 16% for "per primam" anastomoses with frequent need for redo interventions, longer hospitalization and high mortality rates [2]. AL prediction and identification are still difficult due to its different clinical manifestations, varying from vague abdominal symptoms and prolonged postoperative ileus to fulminant abdominal pain in case of peritonitis and sepsis [3].…”

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

“…Ongoing advances in terms of perioperative care and surgical techniques have provided better results in the surgical treatment of patients with colorectal diseases. However, the rate of complications after colorectal surgeries is still high -around 30% -, and anastomotic dehiscence remains a relevant unsolved problem [2][3][4][5] . There is a general consensus on the key role of blood supply, mainly at the bowel margins, for the proper healing of intestinal anastomosis.…”