An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae. (July 2015)

• Record Type: Journal Article
• Authors: Fisher, O. M.; Raptis, D. A.; Vetter, D.; Novak, A.; Dindo, D.; Hahnloser, D.; Clavien, P.‐A.; Nocito, A.
• Is Part Of: Colorectal disease. Volume 17:Number 7(2015)
• Page Start: 619
• Page End: 626
• Publication Date: 2015-07
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.12888
• Languages: English
• ISSNs: 1462-8910

Abstract

<abstract abstract-type="main" id="codi12888-abs-0001"> <title>Abstract</title> <sec id="codi12888-sec-0001" sec-type="section"> <title>Aim</title> <p>The study aimed to compare the rate of success and cost of anal fistula plug (AFP) insertion and endorectal advancement flap (ERAF) for anal fistula.</p> </sec> <sec id="codi12888-sec-0002" sec-type="section"> <title>Method</title> <p>Patients receiving an AFP or ERAF for a complex single fistula tract, defined as involving more than a third of the longitudinal length of of the anal sphincter, were registered in a prospective database. A regression analysis was performed of factors predicting recurrence and contributing to cost.</p> </sec> <sec id="codi12888-sec-0003" sec-type="section"> <title>Results</title> <p>Seventy‐one patients (AFP 31, ERAF 40) were analysed. Twelve (39%) recurrences occurred in the AFP and 17 (43%) in the ERAF group (<italic>P </italic>=<italic> </italic>1.00). The median length of stay was 1.23 and 2.0 days (<italic>P </italic><<italic> </italic>0.001), respectively, and the mean cost of treatment was €5439 ± €2629 and €7957 ± €5905 (<italic>P </italic>=<italic> </italic>0.021), respectively. On multivariable analysis, postoperative complications, underlying inflammatory bowel disease and fistula recurring after previous treatment were independent predictors of <italic>de novo</italic> recurrence. It also showed that length of hospital stay ≤ 1 day to be the most significant independent contributor to lower cost (<italic>P </italic>=<italic> </italic>0.023).</p> </sec> <sec id="codi12888-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Anal fistula plug and ERAF were equally effective in treating fistula‐in‐ano, but AFP has a mean cost saving of €2518 per procedure compared with ERAF. The higher cost for ERAF is due to a longer median length of stay.</p> </sec> </abstract>