Clinical and economic burden of colorectal and bariatric anastomotic leaks

• Published in: Surgical endoscopy Vol. 34; no. 10; pp. 4374 - 4381
• Main Authors: Lee, Sang W., Gregory, David, Cool, Christina L.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-10-2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Abscesses; Adult; Aged; Anastomotic Leak - economics; Anastomotic Leak - etiology; Bariatric Surgery - adverse effects; Bariatric Surgery - economics; Colorectal surgery; Colorectal Surgery - adverse effects; Colorectal Surgery - economics; Cost of Illness; Endoscopy; Female; Gastroenterology; Gastrointestinal surgery; Gynecology; Hepatology; Hospital costs; Humans; Inpatients; Laparoscopy; Length of stay; Length of Stay - economics; Male; Medicare; Medicare - economics; Medicine; Medicine & Public Health; Middle Aged; Patient Readmission; Peritonitis; Proctology; Reimbursement; Retrospective Studies; Risk Factors; Sepsis; Surgery; Surgical anastomosis; United States; Young Adult; United States; Cost analysis; Anastomotic leaks; Intraoperative endoscopy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-019-07210-1

Background
Anastomotic leaks cause a significant clinical and economic burden on patients undergoing bariatric and colorectal surgeries. Current literature shows a wide variation in incidence of anastomotic leaks and a significant gap in associated economic metrics. This analysis utilized claims data to quantify the full episode-of-care cost burden of leaks following colorectal and bariatric surgeries.
Methods
Medicare Fee-for-Service and commercial claims data from a large U.S.-based health plan were queried for cost and utilization of members that underwent bariatric and colorectal surgical procedures between January 1, 2013 and August 31, 2015. Outcomes were collected for members with anastomotic leaks versus those without leaks during the initial hospital stay (index) and within 30 days of the procedure. These outcomes included leak frequency, payer reimbursement, and length of stay (LOS).
Results
The colorectal Medicare analysis identified 239,350 patients undergoing colorectal surgery. For patients with a leak compared to those without, index admission costs were $30,670 greater ($48,982 vs. $18,312;
p
 < 0.0001) and the index LOS was 12 days longer (19 vs. 7 days; p < 0.0001). This finding was similar for the bariatric patients (
n
 = 62,292) where cost was $30,885 higher ($43,918 vs. $13,033;
p
 < 0.0001) and LOS was 15 days longer (17 vs. 2 days;
p
 < 0.0001). Furthermore, readmissions and associated costs were also substantially higher for those with an index leak. The commercial analysis of both the bariatric and colorectal populations trended similarly to the Medicare population in regards to all outcomes measured.
Conclusion
Patients experiencing anastomotic leaks during and after bariatric and colorectal surgery have significantly higher costs and longer LOS both at the initial stay and within 30 days of the procedure. It is important that providers and hospitals understand the economic consequences of these procedures and implement technologies and techniques to prevent/reduce anastomotic leaks.