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The economic impact of anastomotic leakage after anterior resections in E nglish NHS hospitals: are we adequately remunerating them?

2013; Wiley; Volume: 15; Issue: 4 Linguagem: Inglês

10.1111/codi.12125

1463-1318

Shazad Q. Ashraf, Elaine M. Burns, Atul N. Jani, Sheldon G. Altman, Duncan Young, Chris Cunningham, Omar Faiz, N. J. Mortensen,

Esophageal and GI Pathology

Abstract Aim Our aim was to determine the frequency and economic impact of anastomotic leakage (AL) at local and national levels in E ngland. Method All patients who underwent AR in Oxford between 2007 and 2009 were evaluated for AL . H ospital E pisode S tatistics ( HES ) data were used to determine reoperation rates after elective AR ( n = 23 388) in E ngland between 2000 and 2008. Hospital episode remuneration costs were calculated by the local commissioning department and compared with D epartment of H ealth ( DH ) reference index costs. Results The frequency of AL following anterior resection was 10.9% (31 out of 285) in Oxford. Laparotomy for leakage was performed in 5.6% of cases. The 30‐day hospital mortality rate for all AR s was 2.1%, compared with 3.2% after AL . The national relaparotomy rate (within 28 days) and 30‐day hospital mortality in E nglish N ational H ealth S ervice ( NHS ) trusts following AR were 5.9% and 2.9%, respectively. Institutional remunerated tariffs (£6233 ( SD ± 965)) were similar to DH reference costs (£6319 ( SD ± 1830)) after uncomplicated AR . However, there was a significant ( P = 0.008) discrepancy between the remunerated tariff for AL (£9605 ( SD ± 6908)) and the actual cost (£17 220 ( SD ± 9642)). AL resulted in an additional annual cost of approximately £1.1 million to £3.5 million when extrapolated nationally. Conclusion The estimated economic burden of anastomotic leakage following AR is approximately double that of the remunerated tariff.