The Burden of Gastrointestinal Anastomotic Leaks: an Evaluation of Clinical and Economic Outcomes

OBJECTIVE: To evaluate the clinical and economic burden associated with anastomotic leaks following colorectal surgery. METHODS: Retrospective data (January 2008 to December 2010) were analyzed from patients who had colorectal surgery with and without postoperative leaks, using the Premier Perspective™ database. Data on in-hospital mortality, length of stay (LOS), re-admissions, postoperative infection, and costs were analyzed using univariate and multivariate analyses, and the propensity score matching (PSM) and generalized linear models (GLM). RESULTS: Of the patients, 6, 174 (6. 18 %) had anastomotic leaks within 30 days after colorectal surgery. Patients with leaks had 1. 3 times higher 30-day re-admission rates and 0. 8-1. 9 times higher postoperative infection rates as compared with patients without leaks (P < 0. 001 for both). Anastomotic leaks incurred additional LOS and hospital costs of 7. 3 days and 24, 129, respectively, only within the first hospitalization. Per 1, 000 patients undergoing colorectal surgery, the economic burden associated with anastomotic leaks--including hospitalization and re-admission--was established as 9, 500 days in prolonged LOS and 28. 6 million in additional costs. Similar results were obtained from both the PSM and GLM for assessing total costs for hospitalization and re-admission. CONCLUSIONS: Anastomotic leaks in colorectal surgery increase the total clinical and economic burden by a factor of 0. 6-1. 9 for a 30-day re-admission, postoperative infection, LOS, and hospital costs.