The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs

Abstract

Abstract:Objective: To analyse hospital costs in the pre-, and intra-and post-operative periods associated with patients undergoing rectal resection with anastomosis, comparing the costs per patient with and without the use of fibrin-based biological adhesive(Tissucol Duo ® ). Methods: The cost analysis was designed with a subsample of 37 patients who underwent rectal anastomosis in a randomised, single-blind, controlled, parallel comparison between two groups, to evaluate the effectiveness of fibrin-based biological adhesive used to prevent anastomotic leakage. The total costs included diagnostic tests, laboratory tests, hospital stay, adhesive cost, surgery, reintervention and drug treatment. Results: The patients had a mean age of 64.33 years, with a higher proportion of men (62.2%). The study groups were homogeneous and comparable. The average total cost in the group with biological adhesive was€ 10,304.84 compared to € 17,845.12 in the group without biological adhesive. Significant differences were found in the average cost of reintervention between groups: € 119.76 with adhesive vs. € 639.20 for the control group. Conclusions: The total cost decreased by 42% in the group in which a biological adhesive was applied compared to the group in which the adhesive was not applied. This percentage represented a difference of € 7,540.28 in the total average cost per patient.

<p>Costs Analysis of Fibrin Sealant for Prevention of Anastomotic Leakage in Lower Colorectal Surgery</p>

“…A significant difference in AL rates of 18.8% and 52.5% for fibrin sealant and controls, respectively, have previously been reported. 31 The revision rate input was also reported in this study, whereby revision surgery was required in 2 of 16 (12.5%) patients receiving Tisseel, and 9 of 21 (42.9%) patients that received no fibrin sealant to close the anastomoses. 31 Clinical outcomes that were not reported in the Oliver study were identified from other studies with a similar patient population.…”

“…31 The revision rate input was also reported in this study, whereby revision surgery was required in 2 of 16 (12.5%) patients receiving Tisseel, and 9 of 21 (42.9%) patients that received no fibrin sealant to close the anastomoses. 31 Clinical outcomes that were not reported in the Oliver study were identified from other studies with a similar patient population. Hospitalization lengths of 9 days and 9.5 days for Tisseel versus the cohort that did not receive any fibrin sealant were found from the study by Kim et al 20,23 The study reported by Angelini et al reported estimates on bleeding during rectal surgeries which employ fibrin sealant (0.5%) vs no sealant (0.7%).…”

“…Two randomized studies were identified that reflect current treatment practices for rectal resection patients with anastomosis and included appropriate outcomes on which to perform a cost analysis of fibrin sealant. 23,31 The Oliver et al study was chosen for use in the model as it represents the Spanish population. A significant difference in AL rates of 18.8% and 52.5% for fibrin sealant and controls, respectively, have previously been reported.…”

“…As such, there have been several studies investigating fibrin sealant's use in preventing anastomotic leaks in rectal surgeries. 4,20,23,31 Fibrin sealant consists of fibrinogen and thrombin, loaded into two syringes with tips forming a common port. 39 This formulation was designed to mimic the natural hemostasis and wound healing process and aid in closures of surgical incisions.…”

“…6 In Spain, fibrin-based biological adhesives are authorized for use in clinical practice for many indications for achieving hemostasis and tissue sealing during the surgical treatment. 31 Various studies have suggested a relationship between fibrin sealant to seal over sutured ileocolic and colocolic anastomosis. 35 To study treatment practices and resource allocations in this area, we conducted a comparative cost analysis based on differences in outcomes following colorectal surgery, where FS is used to seal over the anastomosis compared to no use of sealant.…”