Department of Anesthesia, Austin Health, Victoria, Australia.
Department of Medicine (Austin Health) & Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, Victoria, Australia.
Medicine (Baltimore). 2021 Jul 9;100(27):e26546. doi: 10.1097/MD.0000000000026546.
Colonic resection is a common surgical procedure that is associated with a high rate of postoperative complications. Postoperative complications are expected to be major contributors to hospital costs. Therefore, this systematic review aims to outline the health costs of postoperative complications following colon resection surgery.
MEDLINE, Excerpta Medica database, Cochrane, and Economics literature medical databases were searched from 2010 to 2019 to identify English studies containing an economic evaluation of postoperative complications following colonic resection in adult patients. All surgical techniques and indications for colon resection were included. Eligible study designs included randomized trials, comparative observational studies, and conference abstracts.
Thirty-four articles met the eligibility criteria. We found a high overall complication incidence with associated increased costs ranging from $2290 to $43,146. Surgical site infections and anastomotic leak were shown to be associated with greater resource utilization relative to other postoperative complications. Postoperative complications were associated with greater incidence of hospital readmission, which in turn is highlighted as a significant financial burden. Weak evidence demonstrates increased complication incidence and costlier complications with open colon surgery as compared to laparoscopic surgery. Notably, we identified a vast degree of heterogeneity in study design, complication reporting and costing methodology preventing quantitative analysis of cost results.
Postoperative complications in colonic resection appear to be associated with a significant financial burden. Therefore, large, prospective, cost-benefit clinical trials investigating preventative strategies, with detailed and consistent methodology and reporting standards, are required to improve patient outcomes and the cost-effectiveness of our health care systems.
结肠切除术是一种常见的外科手术，其术后并发症发生率较高。术后并发症预计将是医院成本的主要贡献者。因此，本系统评价旨在概述结肠切除术后并发症的健康成本。
从 2010 年到 2019 年，检索 MEDLINE、Excerpta Medica 数据库、Cochrane 和经济学文献医学数据库，以确定包含成人结肠切除术后术后并发症的经济评估的英文研究。包括所有手术技术和结肠切除术适应证。合格的研究设计包括随机试验、比较观察性研究和会议摘要。
34 篇文章符合入选标准。我们发现总体并发症发生率较高，相关费用从 2290 美元到 43146 美元不等。与其他术后并发症相比，手术部位感染和吻合口漏显示出与更大的资源利用相关。术后并发症与更高的住院再入院发生率相关，这反过来又被认为是一个重大的财务负担。证据表明，与腹腔镜手术相比，开放性结肠手术的并发症发生率更高，且并发症更昂贵。值得注意的是，我们发现研究设计、并发症报告和成本核算方法存在很大程度的异质性，这使得无法对成本结果进行定量分析。
结肠切除术后的并发症似乎与重大的财务负担有关。因此，需要进行大型、前瞻性、成本效益临床研究，以调查预防策略，采用详细和一致的方法和报告标准，以改善患者的结果和我们医疗保健系统的成本效益。
