Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Tech Coloproctol. 2024 May 20;28(1):55. doi: 10.1007/s10151-024-02932-4.
Anastomotic leakage (AL) remains a burdensome complication following colorectal surgery, with increased morbidity, oncological compromise, and mortality. AL may impose a substantial financial burden on hospitals and society due to extensive resource utilization. Estimated costs associated with AL are important when exploring preventive measures and treatment strategies. The purpose of this study was to systematically review the existing literature on (socio)economic costs associated with AL after colorectal surgery, appraise their quality, compare reported outcomes, and identify knowledge gaps.
Health economic evaluations reporting costs related to AL after colorectal surgery were identified through searching multiple online databases until June 2023. Pairs of reviewers independently evaluated the quality using an adapted version of the Consensus on Health Economic Criteria list. Extracted costs were converted to 2022 euros (€) and also adjusted for purchasing power disparities among countries.
From 1980 unique abstracts, 59 full-text publications were assessed for eligibility, and 17 studies were included in the review. The incremental costs of AL after correcting for purchasing power disparity ranged from €2250 (+39.9%, Romania) to €83,633 (+ 513.1%, Brazil). Incremental costs were mainly driven by hospital (re)admission, intensive care stay, and reinterventions. Only one study estimated the economic societal burden of AL between €1.9 and €6.1 million.
AL imposes a significant financial burden on hospitals and social care systems. The magnitude of costs varies greatly across countries and data on the societal burden and non-medical costs are scarce. Adherence to international reporting standards is essential to understand international disparities and to externally validate reported cost estimates.
吻合口漏（AL）仍然是结直肠手术后的一种负担沉重的并发症，会增加发病率、肿瘤学风险和死亡率。由于广泛利用资源，AL 可能会给医院和社会带来巨大的经济负担。在探讨预防措施和治疗策略时，与 AL 相关的估计成本非常重要。本研究的目的是系统地回顾结直肠手术后与 AL 相关的（社会）经济成本的现有文献，评估其质量，比较报告的结果，并确定知识空白。
通过搜索多个在线数据库，直到 2023 年 6 月，确定了与结直肠手术后 AL 相关的卫生经济评估报告成本。使用经修订的共识健康经济标准清单的版本，由 pairs of reviewers 独立评估质量。提取的成本转换为 2022 年欧元（€），并调整了各国之间的购买力差异。
从 1980 篇独特的摘要中，评估了 59 篇全文出版物的资格，并纳入了 17 项研究进行综述。经购买力差异校正后的 AL 增量成本范围为€2250（+39.9%，罗马尼亚）至€83633（+513.1%，巴西）。增量成本主要由医院（再次）入院、重症监护停留和再次干预驱动。只有一项研究估计了 AL 在经济社会负担介于€190 万至€610 万之间。
AL 给医院和社会护理系统带来了重大的经济负担。成本的幅度在各国之间差异很大，关于社会负担和非医疗成本的数据很少。遵守国际报告标准对于了解国际差异和验证报告的成本估计至关重要。
