Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Surgery. 2010 Jan;147(1):72-8. doi: 10.1016/j.surg.2009.05.018. Epub 2009 Sep 6.
Complex anal fistulas are unsuitable for fistulotomy because of the risk of fecal incontinence. The anal fistula plug (AFP) has demonstrated fistula healing without sphincter division. This study aims to evaluate the cost-effectiveness of the AFP compared to the endoanal advancement flap (EAAF) as an alternative sphincter-preserving option for complex anal fistulas.
The study included 24 patients who underwent treatment for complex anal fistulas. Healing and complication rates of a prospective cohort of AFP patients (n=12) were compared to a retrospective cohort of patients who underwent EAAF (n=12). Cost data were collected after validated healthcare reporting standards. A cost-effectiveness analysis was performed, including extensive modeling of fistula healing rates.
Both cohorts (12 AFP patients and 12 EAAF patients) had similar patient demographics and fistula characteristics. Fistula healing was achieved in 50% (5/12) of AFP patients and 33% (4/12) of EAAF patients (P=.680). Median clinical follow-up was 28 weeks for the AFP patients and 14 weeks for the EAAF patients, whereas median recurrence time was 17.6 weeks (range, 0.4-43.9) and 12.6 weeks (range, 2-34.3), respectively. Use of the AFP instead of the EAAF saved $1,588 (95% confidence interval [CI], $1,211-$1,965; P<.0001), and 1.5 hospital days per healed fistula (P=.0002). This cost-saving effect persisted and amounted to $825 (95% CI, $133-$1,517; P=.022) when the cost estimates were adjusted for the reduction in the hospital length of stay. Extensive modeling over a large range of fistula healing rates confirmed the cost-effectiveness of the AFP.
The AFP is a cost-saving procedure for complex anal fistulas compared to the EAAF.
复杂的肛痿不适合行痿管切开术，因为有发生大便失禁的风险。肛痿塞（AFP）已被证明可以在不损伤括约的情况下愈合痿管。本研究旨在评估 AFP 与经肛门内括约肌切开术（EAAF）相比作为复杂肛痿的一种保留括约的替代方法的成本效益。
本研究纳入了 24 例接受复杂肛痿治疗的患者。前瞻性 AFP 患者队列（n=12）的愈合率和并发症率与接受 EAAF 的回顾性患者队列（n=12）进行了比较。在验证后的医疗保健报告标准后收集了成本数据。进行了成本效益分析，包括对痿管愈合率进行了广泛的建模。
两个队列（12 例 AFP 患者和 12 例 EAAF 患者）的患者人口统计学和痿管特征相似。AFP 患者的痿管愈合率为 50%（5/12），EAAF 患者的愈合率为 33%（4/12）（P=.680）。AFP 患者的中位临床随访时间为 28 周，EAAF 患者的中位随访时间为 14 周，而 AFP 患者的中位复发时间为 17.6 周（范围：0.4-43.9），EAAF 患者的复发时间为 12.6 周（范围：2-34.3）。与 EAAF 相比，使用 AFP 可节省 1588 美元（95%置信区间 [CI]，1211 美元-1965 美元；P<.0001），每愈合一个痿管可节省 1.5 天住院时间（P=.0002）。当对住院时间缩短的成本进行调整时，这种节省成本的效果仍然存在，达到 825 美元（95%CI，133 美元-1517 美元；P=.022）。在大范围痿管愈合率的广泛建模中，AFP 的成本效益得到了证实。
与 EAAF 相比，AFP 是治疗复杂肛痿的一种节省成本的方法。
