Cost and outcomes of side-to-side versus end-to-end anastomosis in right colectomy: a retrospective cohort study

Abstract

Background: The optimal anastomotic configuration for right-sided colectomies remains controversial, with comparable postoperative outcomes across techniques. Thus, economic considerations may play a larger role in decision-making within cost-constrained healthcare settings.

Methods: This retrospective cohort study evaluated right-sided colectomies with ileocolic anastomosis at a Swiss tertiary center between 2016 and 2021. We compared costs and outcomes among three anastomotic techniques: end-to-end (EE), side-to-side stapled (SSS), and side-to-side hand-sewn (SSH).

Results: Out of 468 patients (mean age 67.7 ± 16.2 years; 51.7% female), EE was used in 95 cases (20.3%), SSS in 191 (40.8%), and SSH in 182 (38.9%). The majority (72.0%) underwent elective surgery. Insurance coverage included basic (62.2%), semi-private (24.2%), and private (13.7%). Mean operation times were shortest for EE (173.6 ± 72.3 min), followed by SSS (188.0 ± 65.4 min) and SSH (195.1 ± 61.5 min). The median total costs were 26,449 €. The SSS group had the lowest median total costs, 2424 € less than SSH and 2095 € less than EE, with no significant differences (p = 0.1657). Significant differences were observed in operating room (OR) costs, with EE being the lowest and SSH the highest (p < 0.0001). Adjusted OR costs in SSH were 23% more than EE and 21% more than SSS. No significant difference was found between EE and SSS OR costs. For mean OR material costs, EE had the lowest, followed by SSS and SSH. Adjusted costs for EE were 52% lower than SSS (p = 0.0005) and 65% lower than SSH (p = 0.0191). Clavien-Dindo Grade ≥ III complication rates were 2.1% for EE, 1.9% for SSH, and 3.0% for SSS. Anastomotic leakage occurred in 12 cases (2.6%), and in-hospital mortality was 0.9% (no deaths in EE; two in SSS and SSH each).

Conclusions: EE anastomosis was associated with the lowest OR and material costs in this retrospective analysis while no disadvantages concerning postoperative outcomes could be identified.

Keywords: Costs; Economy; Ileocecal anastomosis; Ileocecal resection; Right colectomy.