IN-HOSPITAL ECONOMIC BURDEN OF ANASTOMOTIC LEAKAGE AFTER COLORECTAL ANASTOMOSIS SURGERY: A REAL-WORLD COST ANALYSIS

OBJECTIVES: Anastomotic Leakage (AL) is a serious complication that may followcolorectal resection, increasing overall costs. The aim of this study was to assessthe additional inpatient economic burden of AL at one Italian hospital.METHODS: 317 patients who underwent colorectal resection between January2015 and December 2016 in Policlinico Universitario Campus Biomedico wereincluded in this retrospective cohort study. For each patient, baseline demographics, clinical characteristics, healthcare resource utilization and costs wereextracted from the hospital’s database. The primary endpoint was inpatient costs.Bivariate comparisons were conducted between patients with and without ALusing Chi square tests for categorical outcomes and t-tests or Wilcoxon rank sumtest for continuous outcomes. RESULTS: Mean (SD) age in the cohort was 66.7(13.2) years and 51.8% of patients were male. 79.5% of patients had malignantdisease and 58.9% had an American Society of Anesthesiologists (ASA) score of 2/6.More patients had laparoscopic surgery (72.6%) compared to open, in 23% of casesderivative stoma was made during the primary operation. 39 patients (12.3%)developed AL during hospital stay. When compared to patients without AL, moreAL patients were male (71.8% vs 51.8%), more had cancer (92.3% vs 77.7%) and morehad a derivative stoma (20.5% vs. 9.9%). Age, surgery approach, are similar in twogroups. In the bivariate analysis, patients with AL had significantly higher totalinpatient costs (V14,781.8 vs V7,110.8, p<0.001), higher LOS (20.1 vs 10.3 days,p<0.001) and ICU admissions (38.5% vs 9.0%, p<0.001) relative to patients withoutAL. CONCLUSIONS: AL increases the inpatient costs 2 times in this Italian hospital.Reducing AL may improve quality of care and substantially reduce hospital costswhile increasing the efficiency of resource utilization.