Oxford Colorectal Centre, Churchill Hospital, Oxford, UK.
Colorectal Dis. 2013 Apr;15(4):e190-8. doi: 10.1111/codi.12125.
Our aim was to determine the frequency and economic impact of anastomotic leakage (AL) at local and national levels in England.
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 (n = 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.
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 (P = 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.
The estimated economic burden of anastomotic leakage following AR is approximately double that of the remunerated tariff.
本研究旨在确定英国局部和全国范围内吻合口漏（AL）的频率和经济影响。
对 2007 年至 2009 年在牛津接受 AR 的所有患者进行 AL 评估。使用医院发病统计（HES）数据确定 2000 年至 2008 年英格兰选择性 AR（n=23388）的再手术率。由当地委托部门计算医院住院费用，并与卫生部（DH）参考指数成本进行比较。
在牛津，前切除术吻合口漏的发生率为 10.9%（31/285）。漏口行剖腹手术的比例为 5.6%。所有 AR 的 30 天院内死亡率为 2.1%，而 AL 后为 3.2%。英国国家卫生服务（NHS）信托机构的全国再剖腹率（28 天内）和 30 天院内死亡率分别为 5.9%和 2.9%。机构报酬率（6233 英镑（SD±965））与简单 AR 的 DH 参考成本（6319 英镑（SD±1830））相似。然而，AL 的报酬率（9605 英镑（SD±6908））与实际成本（17220 英镑（SD±9642））之间存在显著差异（P=0.008）。当外推到全国范围时，AL 导致每年额外增加约 110 万至 350 万英镑的费用。
估计 AR 后吻合口漏的经济负担约为报酬率的两倍。
