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

TLDR

To evaluate the clinical and economic burden associated with anastomotic leaks following colorectal surgery. The study retrospectively analyzed Premier Perspective™ database records from 2008–2010 for colorectal surgery patients with and without leaks, evaluating mortality, length of stay, re‑admissions, infection, and costs via univariate, multivariate, propensity‑score matching, and generalized linear models. Anastomotic leaks occurred in 6.18% of colorectal surgeries and were linked to 1.3‑fold higher 30‑day re‑admission, 0.8–1.9‑fold higher infection rates, an extra 7.3 days of stay and $24,129 in initial hospitalization costs, amounting to 9,500 additional LOS days and $28.6 million per 1,000 procedures, with similar estimates from PSM and GLM, indicating leaks raise clinical and economic burden by 0.6–1.9 times.

Abstract

To evaluate the clinical and economic burden associated with anastomotic leaks following colorectal surgery. Retrospective 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). Of 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. Anastomotic 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.