title: The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?
abstract: OBJECTIVE
  Our aim was to determine the frequency and economic impact of anastomotic leakage (AL) at local and national levels in England.
  
  
  METHODS
  All patients who underwent AR in Oxford between 2007 and 2009 were evaluated for AL. Hospital Episode Statistics (HES) data were used to determine reoperation 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 with 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 National Health Service (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.
  
  
  CONCLUSIONS
  The estimated economic burden of anastomotic leakage following AR is approximately double that of the remunerated tariff.
authors: Oxford Colorectal Centre, Churchill Hospital, Oxford, UK. shazad.ashraf@nds.ox.ac.uk
authors: S Q
authors: SQ
authors: Ashraf
authors: E M
authors: EM
authors: Burns
authors: A
authors: A
authors: Jani
authors: S
authors: S
authors: Altman
authors: J D
authors: JD
authors: Young
authors: C
authors: C
authors: Cunningham
authors: O
authors: O
authors: Faiz
authors: N J
authors: NJ
authors: Mortensen
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma / Q000601:surgery*; D000368:Aged; D057868:Anastomotic Leak / Q000191:economics* / Q000628:therapy*; D004739:England; D004766:Enterostomy / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation / Q000191:economics; D013222:State Medicine / Q000191:economics*