A nationwide population-based study on the clinical and economic burden of anastomotic leakage in colorectal surgery

Fig. 1. Development of surgery numbers from 2013 to 2018 for colon resection and sphincter-preserving rectal resection, anastomotic leakage rates, and risk factors. (A) The total number for colon resections was 87,853 in 2013 and 85,760 in 2018 and for sphincter-preserving rectal resections 31,195 in 2013 and 28,834 in 2018, decreasing slightly over the years. Data are absolute numbers per year. (B) The data show relative anastomotic leakage rates of 5.08% in 2013 and 6.74% in 2018 for colon resections and for sphincter-preserving rectal resections of 7.69% in 2013 and 9.15% in 2018. Data show relative rate per year. A linear trend towards higher leakage rates is shown. Chi-square test for trend, p ≤ 0.0001 = ****. (C, D) Anastomotic leakage rates with regard to secondary diagnosis, age range, and gender for colon resections (C) and sphincter-preserving rectal resections (D). Data are mean ± SD, dots are individual years. Bright blue and bright gray bar are mean leakage rates for all colon resections and all rectal resections. Two-sided Fisher’s exact test (secondary diagnosis, gender), chi-square test (age), p ≤ 0.0001 = ****. AL, anastomotic leakage

Fig. 2. Management of anastomotic leakage and in-house mortality. (A) Procedures following anastomotic leakage after colon and rectal resections (relaparotomy, abdominal vacuum therapy, endorectal vacuum therapy, terminal enterostomy). Rates of procedures in cases with no anastomotic leakage (AL) are depicted for comparison. Data show relative rate per year. Chi-square test for trend. p < 0.05 = *, p ≤ 0.0001 = ****. Data for 2015 not available. (B, C) In-house mortality in % of cases undergoing colon resections (B) or rectal resections (C) without and with anastomotic leakage (AL). Data show relative rate per year. Chi-square test for trend. p < 0.05 = *, p ≤ 0.01 = **, p ≤ 0.0001 = ****. AL, anastomotic leakage

Fig. 3. Length of hospital stay and hospital reimbursement. (A, C) Distribution of cases to the length of hospital stay (≤ 5 days, 6–10 days, 11–20 days, ≥ 20 days). Data is depicted as percentage of total cases for colon resection ± anastomotic leakage (A) and rectal resection ± anastomotic leakage (C). A significant association between anastomotic leakage and length of hospital stay can be shown. Data are mean ± SD. Chi-square test. p ≤ 0.0001 = ****. (B, D) Mean hospital reimbursement sum per case for colon and rectal resections with and without anastomotic leakage. Data are mean reimbursement sum per year, t-test, p ≤ 0.0001 = ****. AL, anastomotic leakage