Eichelmann Ann-Kathrin, Ismail Sarah, Merten Jennifer, Slepecka Patrycja, Palmes Daniel, Laukötter Mike G, Pascher Andreas, Mardin Wolf Arif
Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, W1, 48149, Muenster, Germany.
Department of Medical Controlling, University Hospital of Muenster, Nils-Stensen-Str. 8, 48149, Muenster, Germany.
J Gastrointest Surg. 2021 Oct;25(10):2447-2454. doi: 10.1007/s11605-021-04955-w. Epub 2021 Feb 24.
Endoscopic vacuum therapy (EVT) has become a promising option in the management of anastomotic leakage (AL) after esophagectomy. However, EVT is an effortful approach associated with multiple interventions. In this study, we conduct a comparative cost analysis for methods of management of AL.
All patients who experienced AL treated by EVT, stent, or reoperation following Ivor Lewis esophagectomy for esophageal cancer were included. Cases that were managed by more than one modality were excluded. For the remaining cases, in-patient treatment cost was collected for material, personnel, (par)enteral nutrition, intensive care, operating room, and imaging.
42 patients were treated as follows: EVT n = 25, stent n = 13, and reoperation n = 4. The mean duration of therapy as well as length of overall hospital stay was significantly shorter in the stent than the EVT group (30 vs. 44d, p = 0.046; 34 vs. 53d, p = 0.02). The total mean cost for stent was €33.685, and the total cost for EVT was €46.136, resulting in a delta increase of 37% for EVT vs. stent cost. 75% (€34.320, EVT), respectively, 80% (€26.900, stent) of total costs were caused by ICU stay. Mean pure costs for endoscopic management were relatively low and comparable between both groups (EVT: €1.900, stent: €1.100, p = 0.28).
Management of AL represents an effortful approach that results in high overall costs. The expenses directly related to EVT and stent therapy were however comparatively low with more than 75% of costs being attributable to the ICU stay. Reduction of ICU care should be a central part of cost reduction strategies.
内镜下真空治疗（EVT）已成为食管癌切除术后吻合口漏（AL）管理中的一种有前景的选择。然而，EVT是一种需要多次干预的费力方法。在本研究中，我们对AL的管理方法进行了成本比较分析。
纳入所有在接受Ivor Lewis食管癌切除术后因AL接受EVT、支架置入或再次手术治疗的患者。排除接受多种治疗方式的病例。对于其余病例，收集住院治疗的材料、人员、肠内（或）肠外营养、重症监护、手术室和影像学检查的费用。
42例患者接受了如下治疗：EVT组25例，支架置入组13例，再次手术组4例。支架置入组的平均治疗持续时间和总住院时间明显短于EVT组（30天对44天，p = 0.046；34天对53天，p = 0.02）。支架置入的总平均费用为33685欧元，EVT的总费用为46136欧元，EVT与支架置入费用相比增加了37%。总成本的75%（34320欧元，EVT）和80%（26900欧元，支架置入）是由重症监护病房住院引起的。内镜治疗的平均纯成本相对较低，两组之间具有可比性（EVT：1900欧元，支架置入：1100欧元，p = 0.28）。
AL的管理是一种费力的方法，导致总体成本较高。然而，与EVT和支架治疗直接相关的费用相对较低，超过75%的成本归因于重症监护病房住院。减少重症监护应是成本降低策略的核心部分。
