title: The burden of gastrointestinal anastomotic leaks: an evaluation of clinical and economic outcomes.
abstract: 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.
authors.affiliation: Medical Affairs, Ethicon, Inc, Somerville, NJ, 08876, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hammond
authors.forename: Sangtaeck
authors.initials: S
authors.lastname: Lim
authors.forename: Yin
authors.initials: Y
authors.lastname: Wan
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.forename: Anuprita
authors.initials: A
authors.lastname: Patkar
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D057868:Anastomotic Leak / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D003108:Colonic Diseases / Q000601:surgery*; D003953:Diagnosis-Related Groups; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007239:Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies