Hospital costs of different treatment strategies for anastomotic leakage after total mesorectal excision: a multicentre cost analysis.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-10-08 DOI:10.1007/s10151-025-03215-2

D J Nijssen, K Wienholts, M J Postma, W A Bemelman, J Tuynman, W Laméris, P J Tanis, R Hompes

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引用次数: 0

Abstract

Background: Limited data exist on hospital costs incurred by anastomotic leakage (AL), particularly in relation to specific treatment approaches. This study aimed to analyse the incremental hospital costs of AL after total mesorectal excision (TME), stratified by treatment strategy, over a 1-year time horizon.

Methods: Patients undergoing total mesorectal excision (TME) for rectal cancer (2020-2023), included in the control cohort of the IMARI-study at 15 Dutch centres, were analysed. A cost analysis was conducted according to Dutch National Healthcare Institute guidelines. The primary outcome was the incremental hospital costs incurred by patients with AL detected within 30 days postoperatively, stratified by treatment strategy.

Results: The analysis compared treatment costs in 32 patients with AL and 82 patients without AL. The average hospital costs per patient in the first postoperative year were €15.312. In patients with AL, the mean incremental costs were €24.333. Major cost drivers in the AL group were prolonged hospitalization (+€13.150) and (re)interventions (+€8.910). The treatment costs differed significantly between strategies: no faecal diversion (€10.062), faecal diversion with passive drainage (€23.903), faecal diversion with active drainage (€35.552), and salvage surgery (€38.793).

Conclusions: AL after TME resulted in a nearly fourfold increase in hospital costs compared with patients without AL. Salvage surgery was the most expensive treatment strategy, followed by faecal diversion with active drainage. Future studies should evaluate how these treatment costs relate to clinical success rates, including rates of chronic pelvic sepsis and permanent stomas.

Trial registration: This study used data from the IMARI-study. The IMARI-study is registered with the Dutch Central Committee on Research Involving Human Subjects (NL67600.018.18) and is submitted to the http://www.onderzoekmetmensen.nl/en database (NL-OMON26456 and NL-OMON55903).

查看原文本刊更多论文

全直肠系膜切除术后吻合口漏不同治疗策略的住院费用：一项多中心成本分析

背景：关于吻合口漏（AL）引起的医院费用的数据有限，特别是关于具体治疗方法的数据。本研究旨在分析全肠系膜切除术（TME）后AL的增加住院费用，按治疗策略分层，为期1年。方法：对荷兰15个中心imari研究的对照队列中接受直肠癌全肠系膜切除术（TME）（2020-2023）的患者进行分析。根据荷兰国家卫生保健研究所的指导方针进行了成本分析。主要结局是术后30天内发现AL患者的住院费用增量，并按治疗策略分层。结果：分析比较了32例AL患者和82例非AL患者的治疗费用，术后第一年平均住院费用为15.312欧元。在AL患者中，平均增量成本为24.333欧元。AL组的主要费用驱动因素是延长住院时间（+ 13.150欧元）和（重新）干预（+ 8.910欧元）。治疗费用在以下策略之间差异显著：无大便改道（10.062欧元）、大便改道合并被动引流（23.903欧元）、大便改道合并主动引流（35.552欧元）和挽救性手术（38.793欧元）。结论：与未发生AL的患者相比，TME后AL的住院费用增加了近四倍。挽救性手术是最昂贵的治疗策略，其次是粪便分流和主动引流。未来的研究应该评估这些治疗费用与临床成功率的关系，包括慢性盆腔败血症和永久性造口的发生率。试验注册：本研究使用来自imari研究的数据。imari研究已在荷兰人类受试者研究中心委员会（NL67600.018.18）注册，并提交至http://www.onderzoekmetmensen.nl/en数据库（NL-OMON26456和NL-OMON55903）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.