Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 20;28(1):55.
doi: 10.1007/s10151-024-02932-4.

The economic impact of anastomotic leakage after colorectal surgery: a systematic review

David J Nijssen #  1   2 , Kiedo Wienholts #  3   4   5 , Maarten J Postma  6   7 , Jurriaan Tuynman  4   8 , Willem A Bemelman  3   4   5 , Wytze Laméris  4   8 , Roel Hompes  9   10
Affiliations

The economic impact of anastomotic leakage after colorectal surgery: a systematic review

David J Nijssen et al. Tech Coloproctol. .

Abstract

Background: Anastomotic leakage (AL) remains a burdensome complication following colorectal surgery, with increased morbidity, oncological compromise, and mortality. AL may impose a substantial financial burden on hospitals and society due to extensive resource utilization. Estimated costs associated with AL are important when exploring preventive measures and treatment strategies. The purpose of this study was to systematically review the existing literature on (socio)economic costs associated with AL after colorectal surgery, appraise their quality, compare reported outcomes, and identify knowledge gaps.

Methods: Health economic evaluations reporting costs related to AL after colorectal surgery were identified through searching multiple online databases until June 2023. Pairs of reviewers independently evaluated the quality using an adapted version of the Consensus on Health Economic Criteria list. Extracted costs were converted to 2022 euros (€) and also adjusted for purchasing power disparities among countries.

Results: From 1980 unique abstracts, 59 full-text publications were assessed for eligibility, and 17 studies were included in the review. The incremental costs of AL after correcting for purchasing power disparity ranged from €2250 (+39.9%, Romania) to €83,633 (+ 513.1%, Brazil). Incremental costs were mainly driven by hospital (re)admission, intensive care stay, and reinterventions. Only one study estimated the economic societal burden of AL between €1.9 and €6.1 million.

Conclusions: AL imposes a significant financial burden on hospitals and social care systems. The magnitude of costs varies greatly across countries and data on the societal burden and non-medical costs are scarce. Adherence to international reporting standards is essential to understand international disparities and to externally validate reported cost estimates.

Keywords: Anastomotic leakage; Cost analysis; Health economic evaluation; Socioeconomic burden; Systematic review.

PubMed Disclaimer

Conflict of interest statement

Stryker European Operations B.V. provided funding for conducting this study. R.H. receives grants and materials from Stryker European Operations B.V. and consultancy fees from Applied Medical. M.J.P. reports grants and honoraria from various pharmaceutical companies, all unrelated to this research; is an advisor of Asc Academics; and holds stocks from Health-Ecore and Pharmacoeconomics Advice Groningen. W.A.B. has received grants from Braun and Vifor, and has served as speaker for Takeda, Johnson and Johnson, and Braun. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Disclosure: the authors declare no other conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the study screening and selection. From: Page et al. [11]. 10.1136/bmj.n71
Fig. 2
Fig. 2
Quality assessment of the included studies by the adapted CHEC list. The mean score of reviewer 1 and 2 is depicted by the horizontal black line. An overview of the included scoring items from the original CHEC list can be found in supplementary file 2
Fig. 3
Fig. 3
Specification of costs of AL compared with no AL. AL anastomotic leakage, ICU intensive care unit, NR not reported. General or unspecified costs were mentioned in the referred articles as: “costs other departments,” “building cost management,” “external service,” “administrative costs.” All costs are presented in 2022 euros (€) with proportions (%) of total costs horizontally presented. Costs are not corrected for purchasing power disparities
See this image and copyright information in PMC

References

    1. Zarnescu EC, Zarnescu NO, Costea R (2021) Updates of risk factors for anastomotic leakage after colorectal surgery. Diagnostics 11(12):2382 - PMC - PubMed
    1. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis 32(4):549–556 - PMC - PubMed
    1. Denost Q et al. (2021) Impact of early biochemical diagnosis of anastomotic leakage after rectal cancer surgery: long-term results from GRECCAR 5 trial. Br J Surg 108(6):605–608 - PubMed
    1. Ashraf S et al. (2013) The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them? Colorectal Dis 15(4):e190–e198 - PubMed
    1. Vonlanthen R et al. (2011) The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg 254(6):907–913 - PubMed

Publication types

MeSH terms

LinkOut - more resources