Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Diagnostic and Interventional Radiology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany.
Langenbecks Arch Surg. 2023 Jan 23;408(1):55. doi: 10.1007/s00423-023-02809-4.
Anastomotic leakage (AL) is one of the most dreaded complications in colorectal surgery. In 2013, the International Classification of Diseases code K91.83 for AL was introduced in Germany, allowing nationwide analysis of AL rates and associated parameters. The aim of this population-based study was to investigate the current incidence, risk factors, mortality, clinical management, and associated costs of AL in colorectal surgery.
A data query was performed based on diagnosis-related group data of all hospital cases of inpatients undergoing colon or sphincter-preserving rectal resections between 2013 and 2018 in Germany.
A total number of 690,690 inpatient cases were included in this study. AL rates were 6.7% for colon resections and 9.2% for rectal resections in 2018. Regarding the treatment of AL, the application of endoluminal vacuum therapy increased during the studied period, while rates of relaparotomy, abdominal vacuum therapy, and terminal enterostomy remained stable. AL was associated with significantly increased in-house mortality (7.11% vs. 20.11% for colon resections and 3.52% vs. 11.33% for rectal resections in 2018) and higher socioeconomic costs (mean hospital reimbursement volume per case: 14,877€ (no AL) vs. 37,521€ (AL) for colon resections and 14,602€ (no AL) vs. 30,606€ (AL) for rectal resections in 2018).
During the studied time period, AL rates did not decrease, and associated mortality remained at a high level. Our study provides updated population-based data on the clinical and economic burden of AL in Germany. Focused research in the field of AL is still urgently necessary to develop targeted strategies to prevent AL, improve patient care, and decrease socioeconomic costs.
吻合口漏（AL）是结直肠手术中最可怕的并发症之一。2013 年，德国引入了国际疾病分类第 K91.83 编码用于 AL，从而实现了全国范围内对 AL 发生率和相关参数的分析。本基于人群的研究旨在调查结直肠手术中 AL 的当前发生率、危险因素、死亡率、临床管理和相关费用。
基于德国 2013 年至 2018 年间所有住院行结肠或保肛直肠切除术的患者的诊断相关组数据进行了数据查询。
本研究共纳入 690690 例住院患者。2018 年，结肠切除术的 AL 发生率为 6.7%，直肠切除术的 AL 发生率为 9.2%。关于 AL 的治疗，腔内真空治疗的应用在研究期间有所增加，而再次剖腹手术、腹部真空治疗和末端肠造口术的比例保持稳定。AL 与院内死亡率显著增加相关（2018 年结肠切除术分别为 7.11%和 20.11%，直肠切除术分别为 3.52%和 11.33%），且社会经济成本更高（每例平均医院报销金额：2018 年无 AL 时为 14877 欧元（无 AL），有 AL 时为 37521 欧元（有 AL），无 AL 时为 14602 欧元（无 AL），有 AL 时为 30606 欧元（有 AL））。
在研究期间，AL 发生率没有降低，相关死亡率仍处于较高水平。本研究提供了德国 AL 的临床和经济负担的最新基于人群的数据。在 AL 领域进行有针对性的研究仍然是迫切需要的，以制定预防 AL、改善患者护理和降低社会经济成本的目标策略。
