The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?. (27th March 2013)

• Record Type: Journal Article
• Authors: Ashraf, S. Q.; Burns, E. M.; Jani, A.; Altman, S.; Young, J. D.; Cunningham, C.; Faiz, O.; Mortensen, N. J.
• Is Part Of: Colorectal disease. Volume 15:Number 4(2013)
• Page Start: e190
• Page End: e198
• Publication Date: 2013-03-27
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.12125
• Languages: English
• ISSNs: 1462-8910

Abstract

<abstract abstract-type="main" xml:lang="en" id="codi12125-abs-0001"> <title>Abstract</title> <sec id="codi12125-sec-0001" sec-type="section"> <title>Aim</title> <p>Our aim was to determine the frequency and economic impact of anastomotic leakage (AL) at local and national levels in England.</p> </sec> <sec id="codi12125-sec-0002" sec-type="section"> <title>Method</title> <p>All patients who underwent AR in Oxford between 2007 and 2009 were evaluated for AL. Hospital Episode Statistics (HES) data were used to determine reoperation rates after elective AR (<italic>n </italic>= 23 388) in England between 2000 and 2008. Hospital episode remuneration costs were calculated by the local commissioning department and compared with Department of Health (DH) reference index costs.</p> </sec> <sec id="codi12125-sec-0003" sec-type="section"> <title>Results</title> <p>The frequency of AL following anterior resection was 10.9% (31 out of 285) in Oxford. Laparotomy for leakage was performed in 5.6% of cases. The 30‐day hospital mortality rate for all ARs was 2.1%, compared with 3.2% after AL. The national relaparotomy rate (within 28 days) and 30‐day hospital mortality in English National Health Service (NHS) trusts following AR were 5.9% and 2.9%, respectively. Institutional remunerated tariffs (£6233 (SD ± 965)) were similar to DH reference costs (£6319 (SD ± 1830)) after uncomplicated AR. However, there was a significant (<italic>P </italic>= 0.008) discrepancy between the remunerated tariff for AL (£9605 (SD ± 6908)) and the actual cost (£17 220 (SD ± 9642)). AL resulted in an additional annual cost of approximately £1.1 million to £3.5 million when extrapolated nationally.</p> </sec> <sec id="codi12125-sec-0004" sec-type="section"> <title>Conclusion</title> <p>The estimated economic burden of anastomotic leakage following AR is approximately double that of the remunerated tariff.</p> </sec> </abstract>