Abstract
Background
Anastomotic leaks cause a significant clinical and economic burden on patients undergoing bariatric and colorectal surgeries. Current literature shows a wide variation in incidence of anastomotic leaks and a significant gap in associated economic metrics. This analysis utilized claims data to quantify the full episode-of-care cost burden of leaks following colorectal and bariatric surgeries.
Methods
Medicare Fee-for-Service and commercial claims data from a large U.S.-based health plan were queried for cost and utilization of members that underwent bariatric and colorectal surgical procedures between January 1, 2013 and August 31, 2015. Outcomes were collected for members with anastomotic leaks versus those without leaks during the initial hospital stay (index) and within 30 days of the procedure. These outcomes included leak frequency, payer reimbursement, and length of stay (LOS).
Results
The colorectal Medicare analysis identified 239,350 patients undergoing colorectal surgery. For patients with a leak compared to those without, index admission costs were $30,670 greater ($48,982 vs. $18,312; p < 0.0001) and the index LOS was 12 days longer (19 vs. 7 days; p < 0.0001). This finding was similar for the bariatric patients (n = 62,292) where cost was $30,885 higher ($43,918 vs. $13,033; p < 0.0001) and LOS was 15 days longer (17 vs. 2 days; p < 0.0001). Furthermore, readmissions and associated costs were also substantially higher for those with an index leak. The commercial analysis of both the bariatric and colorectal populations trended similarly to the Medicare population in regards to all outcomes measured.
Conclusion
Patients experiencing anastomotic leaks during and after bariatric and colorectal surgery have significantly higher costs and longer LOS both at the initial stay and within 30 days of the procedure. It is important that providers and hospitals understand the economic consequences of these procedures and implement technologies and techniques to prevent/reduce anastomotic leaks.
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Acknowledgements
The authors would like thank Mr. Keith Needham, Manager with Baker Tilly, and Mr. Christopher Adams, MPH, Senior Consultant with Baker Tilly for their analytical support on this important piece of economic research.
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Olympus Corporation of the Americas, Central Valley, PA.
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Dr. Lee is a consultant for Olympus Corporation of the Americas, Ms. Cool has no conflict of interest or financial ties to disclose. Mr. Gregory is a partner with Baker Tilly and Baker Tilly receives management consulting fees from Olympus for various data analytic support activities.
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Appendix
Appendix
Coding for anastomotic leak, bariatric and colorectal procedures
ICD-9 code | Description |
|---|---|
ICD-9: anastomotic leak case identification codes | |
041.04 | Streptococcus infection in conditions classified elsewhere and of unspecified site, Group D [Enterococcus] |
041.49 | Other and unspecified Escherichia coli [E. coli] unspecified site exclude? |
041.85 | Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms unspecified site exclude? |
539.81 | Infection due to other bariatric procedure |
567.0 | Peritonitis and retroperitoneal infections: peritonitis in infectious diseases classified elsewhere |
567.21 | Other suppurative peritonitis: peritonitis (acute) generalized |
567.22 | Other suppurative peritonitis: peritoneal abscess |
569.5 | Abscess of intestine |
569.81 | Fistula of intestine, excluding rectum and anus |
569.83 | Perforation of intestine |
790.7 | Bacterimia |
998.31 | Disruption of internal operation (surgical) wound |
998.59 | Other postoperative infection |
998.6 | Persistent postoperative fistula |
038.4 | Septicemia due to other gram-negative organisms |
038.8 | Other specified septicemia |
038.9 | Unspecified septicemia |
54.11 | Exploratory laparotomy (procedure code) |
54.12 | Reopening of recent laparotomy site (procedure code) |
54.0 | Incision of abdominal wall (procedure code) |
54.19 | Other laparotomy (procedure code) |
54.91 | Percutaneous abdominal drainage (procedure code) |
ICD-9: bariatric procedure codes | |
43.82 | Laparoscopic sleeve gastrectomy |
43.89 | Open and other partial gastrectomy |
44.31 | High gastric bypass |
44.38 | Laparoscopic gastroenterostomy |
44.39 | Other gastroenterostomy without gastrectomy |
43.6 | Partial gastrectomy with anastomosis to duodenum |
43.7 | Partial gastrectomy with anastomosis to jejunum |
44.5 | Revision of gastric anastomosis |
ICD-9: colorectal procedure codes | |
17.31 | Laparoscopic multiple segmentation of large intestine |
17.32 | Laparoscopic cecectomy |
17.33 | Laparoscopic right hemicolectomy |
17.34 | Laparoscopic resection of transverse colon |
17.35 | Laparoscopic left hemicolectomy |
17.36 | Laparoscopic sigmoidectomy |
17.39 | Other laparoscopic partial excision of large intestine |
45.71 | Open and multiple segmentation resection of large intestine |
45.72 | Open and other cecetomy |
45.73 | Open and right hemicolectomy |
45.74 | Open and other transverse colon |
45.75 | Open and left hemicolectomy |
45.76 | Open and other sigmoidectomy |
45.79 | Other and unspecified partial excision of large intestine |
45.81 | Laparoscopic total intra-abdominal colectomy |
45.82 | Open total intra-abdominal colectomy |
45.83 | Other and unspecified total intra-abdominal colectomy |
45.9 | Intestinal anastomosis, not specified |
45.91 | Small to small intestinal anastomosis |
45.92 | Anastomosis to rectal |
45.93 | Other small to large intestinal anastomosis |
45.94 | Large to large intestinal anastomosis |
45.95 | Anastomosis to anus |
46.94 | Revision of anastomosis of large intestine |
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Lee, S.W., Gregory, D. & Cool, C.L. Clinical and economic burden of colorectal and bariatric anastomotic leaks. Surg Endosc 34, 4374–4381 (2020). https://doi.org/10.1007/s00464-019-07210-1
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DOI: https://doi.org/10.1007/s00464-019-07210-1