Browning Alison F, Chong Lynn, Read Matthew, Hii Michael W
Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2022 Nov;92(11):2901-2906. doi: 10.1111/ans.18062. Epub 2022 Sep 21.
Oesophageal cancer is the seventh most prevalent malignancy globally, and the sixth most common cause of cancer-related death. Oesophageal cancer is also one of the most costly cancers to treat. The aim of this study was to assess the financial impact of post-operative morbidity and hospital readmissions following oesophagectomy for oesophageal cancer.
A retrospective analysis was performed on a prospectively maintained database of patients with oesophageal cancer who underwent an oesophagectomy at a single centre between July 2014 and June 2019 (N = 56). Readmission costs were also assessed in this cohort for 12 months post-operatively.
The total median cost for oesophagectomy in this cohort was AU$57 250. Major complications occurred in 40% of patients, with a median total admission cost of AU$74 606, significantly higher than patients with either minor or no complications (median admission cost of AU$52 713, P < 0.001). Patients whose operation was complicated by an anastomotic leak had a higher median admission cost than those without a leak (AU$104 328 and AU$54 972 respectively, P < 0.001). Cost centres representing the greatest proportion of costs were theatre resources and surgical ward care (medical and nursing). A total of 110 readmissions in 25 patients were recorded in the 12 months post-operatively, the majority for gastroscopy and dilatation of anastomotic stricture.
Post-oesophagectomy morbidity greatly increases cost of care. In addition to the clinical benefits, interventions to minimize post-operative complications are likely to result in substantial cost savings.
食管癌是全球第七大常见恶性肿瘤，也是癌症相关死亡的第六大常见原因。食管癌也是治疗成本最高的癌症之一。本研究的目的是评估食管癌食管切除术后并发症和再次入院的经济影响。
对2014年7月至2019年6月在单一中心接受食管切除术的食管癌患者前瞻性维护数据库进行回顾性分析（N = 56）。还对该队列术后12个月的再入院费用进行了评估。
该队列中食管切除术的总中位费用为57250澳元。40%的患者发生了主要并发症，总入院中位费用为74606澳元，显著高于轻度或无并发症患者（入院中位费用为52713澳元，P < 0.001）。手术并发吻合口漏的患者入院中位费用高于无漏患者（分别为104328澳元和54972澳元，P < 0.001）。占成本比例最大的成本中心是手术室资源和外科病房护理（医疗和护理）。术后12个月共记录了25例患者的110次再入院，大多数是因为胃镜检查和吻合口狭窄扩张。
食管切除术后的并发症大大增加了护理成本。除了临床益处外，尽量减少术后并发症的干预措施可能会大幅节省成本。
