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AIM: Anastomotic leakage (AL) is a major complication following anterior resection (AR). Our aim was to determine the frequency and economic impact of this complication at local and national levels in England. METHOD: All patients who underwent AR in Oxford between 2007 and 2009 were evaluated for AL. Hospital Episode Statistics (HES) data were used to determine re-operation rates after elective AR (n=23,388) in England between 2000 and 2008. Hospital episode remuneration costs were calculated by the local commissioning department and compared to Department of Health (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 ARs was 2.1%, compared with 3.2% after AL. The national relaparotomy rate (within 28 days) and 30-day hospital mortality in English NHS trusts following AR were 5.9% and 2.9%, respectively. Institutional remunerated tariffs ( pound6,233 (SD +/-965)) were similar to DH reference costs ( pound6,319 (SD +/-1,830)) after uncomplicated AR. However, there was a significant (p=0.008) discrepancy between the remunerated tariff for AL ( pound9,605 (SD +/-6,908)) and the actual cost ( pound17,220 (SD +/-9,642)). AL resulted in an additional annual cost of approximately pound1.1 to 3.5 million when extrapolated nationally. CONCLUSION: When reference costs are used, the estimated economic burden of anastomotic leakage following AR is approximately double that of the remunerated tariff. (c) 2013 The Authors. Colorectal Disease (c) 2013 The Association of Coloproctology of Great Britain and Ireland.

Original publication

DOI

10.1111/codi.12125

Type

Journal article

Journal

Colorectal Diseases

Publication Date

22/01/2013