The Clinical and Economic Burden of Colorectal Anastomotic Leaks: Middle-Income Country Perspective

Ribeiro, Ulysses; Tayar, Daiane Oliveira; Ribeiro, Rodrigo Antonini; Andrade, P.C.; Junqueira, Silvio Mauro

doi:10.1155/2019/2879049

Cited by 11 publications

(15 citation statements)

References 27 publications

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“…Ashraf et al [ 16 ] found an increase of 154% in the mean in-patient hospital cost for 20 patients with anastomotic leakage after anterior resection (£6233 ± £965 vs £9605 ± £6908 for non-CAL and CAL patients, respectively). Similar results were observed by other studies[ 2 , 25 , 26 ].…”

Section: Discussionsupporting

confidence: 93%

Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope?

Rama¹,

Lourenço²,

Lima³

et al. 2022

World J Gastrointest Surg

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BACKGROUND Colorectal anastomotic leakage (CAL), a severe postoperative complication, is associated with high morbidity, hospital readmission, and overall healthcare costs. Early detection of CAL remains a challenge in clinical practice. However, some decision models have been developed to increase the diagnostic accuracy of this event. AIM To develop a score based on easily accessible variables to detect CAL early. METHODS Based on the least absolute shrinkage and selection operator method, a predictive classification system was developed [Early ColoRectAL Leakage (E-CRALL) score] from a prospective observational, single center cohort, carried out in a colorectal division from a non-academic hospital. The score performance and CAL threshold from postoperative day (POD) 3 to POD5 were estimated. Based on a precise analytical decision model, the standard clinical practice was compared with the E-CRALL adoption on POD3, POD4, or POD5. A cost-minimization analysis was conducted, on the assumption that all alternatives delivered similar health-related effects. RESULTS In this study, 396 patients who underwent colorectal resection surgery with anastomosis, and 6.3% ( n = 25) developed CAL. Most of the patients who developed CAL ( n = 23; 92%) were diagnosed during the first hospital admission, with a median time of diagnosis of 9.0 ± 6.8 d. From POD3 to POD5, the area under the receiver operating characteristic curve of the E-CRALL score was 0.82, 0.84, and 0.95, respectively. On POD5, if a threshold of 8.29 was chosen, 87.4% of anastomotic failures were identified with E-CRALL adoption. Additionally, score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d, if used on POD3 and POD5, respectively. Regardless of score adoption, episode comprehensive costs were markedly greater (up to four times) in patients who developed CAL in comparison with patients who did not develop CAL. Nonetheless, the use of the E-CRALL warning score was associated with cost savings of €421442.20, with most (92.9%) of the savings from patients who did not develop CAL. CONCLUSION The E-CRALL score is an accessible tool to predict CAL at an early timepoint. Additionally, E-CRALL can reduce overall healthcare costs, mainly in the reduction of hospital costs, independent of whether a patient developed CAL.

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Section: Discussionsupporting

confidence: 93%

Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope?

Rama¹,

Lourenço²,

Lima³

et al. 2022

World J Gastrointest Surg

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“…Ribeiro Jr et al reported similar results, highlighting that ALs increased antibiotic use by nearly 70%. 6 Similar results were found in other studies as well. 7…”

Section: Antibiotic Usagesupporting

confidence: 89%

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

Élthes

Török

Dénes³

et al. 2020

Journal of Interdisciplinary Medicine

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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.

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“…In this sense, our study is the first to estimate the annual cost of AL management in patients with CRC using two prospective, multicentre audits conducted at the national level [ 10 , 11 ]. This is unlike the literature, which has depended on data obtained from groups related to diagnosis (DRGs), retrospective studies or databases of single hospitals [ 23 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

The economic impact of anastomotic leak after colorectal cancer surgery

et al. 2023

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Objective To determine the economic impact of the incremental consumption of resources for the diagnosis and treatment of anastomotic leak (AL) in patients after resection with anastomosis for colorectal cancer compared to patients without AL on the Spanish health system. Method This study included a literature review with parameters validated by experts and the development of a cost analysis model to estimate the incremental resource consumption of patients with AL versus those without. The patients were divided into three groups: 1) colon cancer (CC) with resection, anastomosis and AL; 2) rectal cancer (RC) with resection, anastomosis without protective stoma and AL; and 3) RC with resection, anastomosis with protective stoma and AL. Results The average total incremental cost per patient was €38,819 and €32,599 for CC and RC, respectively. The cost of AL diagnosis per patient was €1018 (CC) and €1030 (RC). The cost of AL treatment per patient in Group 1 ranged from €13,753 (type B) to €44,985 (type C + stoma), that in Group 2 ranged from €7348 (type A) to €44,398 (type C + stoma), and that in Group 3 ranged from €6197 (type A) to €34,414 (type C). Hospital stays represented the highest cost for all groups. In RC, protective stoma was found to minimize the economic consequences of AL. Conclusions The appearance of AL generates a considerable increase in the consumption of health resources, mainly due to an increase in hospital stays. The more complex the AL, the higher the cost associated with its treatment. Interest of the study it is the first cost-analysis study of AL after CR surgery based on prospective, observational and multicenter studies, with a clear, accepted and uniform definition of AL and estimated over a period of 30 days.

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The Clinical and Economic Burden of Colorectal Anastomotic Leaks: Middle-Income Country Perspective

Cited by 11 publications

References 27 publications

Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope?

Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope?

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

The economic impact of anastomotic leak after colorectal cancer surgery

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