In-hospital economic burden of anastomotic leakage after colorectal anastomosis surgery: a real-world cost analysis in Italy

ABSTRACT

Background

Anastomotic leakage (AL) is a severe complication of colorectal surgery. We aimed to quantify inpatient costs and key cost contributors associated with AL in a single Italian center.

Research design and methods

Electronic records for adults who had undergone colorectal surgery with anastomosis (January 2015 – December 2016), were retrospectively reviewed. Patients with AL were identified using clinical signs and/or imaging findings and/or intraoperative findings. Available data included patient, clinical, and procedural characteristics, healthcare resource utilization, and inpatient costs. Multivariate models were used to adjust for potential confounders.

Results

AL occurred in 12.3% of patients (N = 317). Mean adjusted inpatient cost was 108% higher (p < 0.001) for patients with AL versus no AL (€14,711; 95% CI: 12,113; 17,866 versus €7,089; 95% CI: 6,623; 7,587). Key cost contributors were ward stay, disposables, operating room, and hospital consultations. Mean losses (reimbursement minus costs) were €2,041/patient with AL. AL extended mean length of stay by 9 days and increased odds of reoperation and ICU stay (all p < 0.001).

Conclusions

Patients with AL place considerable economic and resource burden on healthcare systems and hospital reimbursement rates do not cover treatment costs. This study highlights an unmet need for novel techniques to reduce the burden of AL.

KEYWORDS:

• Anastomotic leak
• colorectal surgery
• health care costs
• observational study
• Italy

Acknowledgments

The authors thank Orla Fannon, PhD (Mtech Access, Bicester, UK) who provided medical writing services in the preparation of the manuscript, funded by Johnson & Johnson Medical SpA.

Declaration of Interests

Thibaut Galvain, Cindy Tong and Vito Paragò are employees of Johnson & Johnson. The institution of Gabriella Teresa Capolupo, Gianluca Mascianà, Stefano Di Berardino, Damiano Caputo, Vincenzo La Vaccara and Marco Caricato received a grant from Johnson & Johnson for this study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Author contributions

All authors participated to the study design, data analysis and manuscript writing. Gabriella Teresa Capolupo, Gianluca Mascianà, Stefano Di Berardino, Damiano Caputo, Vincenzo La Vaccara and Marco Caricato participated in the data collection. All authors give final approval of the version to be published and agree to be accountable for all aspects of the work.

Previous presentations

This study was previously presented at ISPOR Europe, 10–14 November 2018, Barcelona, Spain

Additional information

Funding

This study was sponsored by Johnson & Johnson Medical SpA.