Economic Impact of Anastomotic Leaks in Colectomy Procedures in the USA: 2005-2009

Lobat Hashemi, MS, Nilay Mukherjee, PhD, Michael Morseon, MS, Rhea Sirkar. Covidien


INTRODUCTION: Colectomy procedures to remove a portion of the large intestine are performed in patients with cancer, diverticulitis, trauma and inflammatory bowel disease. The anastamosis between the joined portions of the large intestine can leak, often with serious consequences for the patient such as peritonitis that can result in prolonged hospital stay and higher complication rates.
METHODS: We identified a set of colectomy procedures most prone to leaks based on a survey of the literature and consulting with colorectal surgeons. We then developed a work structure for these surgeries as well as additional procedures that need to be done in the event of a post-operative leak. Patient profiles were then created from this information in terms of ICD9 procedure codes that are likely to be associated with patients that leaked versus those that did not leak. The Premier Perspective™ Database was used to estimate the incidence and costs of postoperative anastomotic leaks from colectomy procedures, annually, from 2005 to 2009. PPD is the largest hospital-based database in the United States providing detailed resource utilization and cost data. Our study focused on several ICD-9-CM procedures including 45.73 (Open and other right hemicolectomy), 45.76 (Open and other sigmoidectomy), 45.75 (Open and other left hemicolectomy), 48.63 (Other anterior resection of rectum).
RESULTS: A total of 46,788 (19.9%) patients with colectomy procedures had ICD9 codes that suggest an anastomotic leak between 2005 and 2009. Table 1 describes the trend in volume, cost, and hospital length of stay (LOS) for colectomy patients with and without anastomotic leak from 2005 through 2009. The percentage of patients with ICD9 codes suggestive of an anastomotic leak increased from 16.2% in 2005 to 22.1% in 2009. The mean cost per discharge for patients with an anastomotic leak was significantly higher than those patients without leaks each year. Patients with anastomotic leaks cost approximately seventeen thousand dollars more than patients without a leak. Average hospital LOS was significantly lower for patients without leaks than patients with leaks, 8.4 days compared to 14.9 days, respectively. Average hospital LOS stayed relatively flat at 15 days for patients with leaks from 2005 to 2009. Average hospital LOS decreased slightly from 8.9 days in 2005 to 8 days in 2009 for patient without anastomotic leaks.
CONCLUSIONS: Anastomotic leaks present a major clinical problem. Mean cost per discharge and length of stay for patients with an anastomotic leak was significantly higher than the mean cost per discharge for those without a leak. These observations highlight the potential cost advantages of preventing anastomotic leaks for patients undergoing colectomy procedures. 

 With Anastomotic Leaks  Without Anastomotic Leaks   
YearN(%)Mean CostMean LOS (days)NMean COstMean LOS (days)p-value
20056,944 (16.2%)$30,731 15.1 35,982 $11,822 8.9<.001 
20069,570 (19.4%)$31,204 14.8 39,637 $12,189 8.5 <.001
20079,859 (20.4%) $32,718 14.8 38,538 $12,782 8.4 <.001
20089,529 (21.0%) $35,943 15.0 35,943 $13,259 8.2 <.001
200910,706 (22.1%) $37,042 15.0 37,829 $13,674 8.0 <.001
All years46,788 (19.9%) $33,754 14.9 187,870 $12,751 8.4 <.001


Session Number: Poster – Poster Presentations
Program Number: P027
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