• J. Thorac. Cardiovasc. Surg. · May 2019

    The cost burden of clinically significant esophageal anastomotic leaks-a steep price to pay.

    • John Agzarian, Sue L Visscher, Ariel W Knight, Mark S Allen, Stephen D Cassivi, Francis C Nichols, K Robert Shen, Dennis Wigle, and Shanda H Blackmon.
    • Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester. Electronic address: agzarij@mcmaster.ca.
    • J. Thorac. Cardiovasc. Surg. 2019 May 1; 157 (5): 2086-2092.

    ObjectiveThe purpose of this retrospective cohort study was to evaluate resource consumption of clinically significant esophageal anastomotic leaks.MethodsBetween September 1, 2008, to December 31, 2014, a prospectively maintained database was queried to identify patients with grade III to IV anastomotic leaks after esophagectomy for esophageal cancer. Inflation-adjusted standardized costs were applied to billed services related to leak diagnosis and treatment, from time of leak detection to resumption of oral diet. A matched analysis was used to compare average expenditures in patients without vs. those with an anastomotic leak.ResultsOf 448 patients undergoing esophagectomy after neoadjuvant treatment, 399 patients met inclusion criteria. Twenty-four grade III to IV anastomotic leaks were identified (6% leak rate). Five transhiatal esophagectomies accounted for 20.8% of cases, whereas 9 Ivor Lewis and 10 McKeown esophagectomies accounted for 37.5% and 41.7%, respectively. The median time required to treat an anastomotic leak was 73 days (range 14-701). The additional median standardized cost per leak was $68,296 (mean $119,822). Matched analysis demonstrated that mean treatment costs were 2.6 times greater for patients with an anastomotic leak. This was primarily attributed to prolonged hospitalization, with post-leak detection length of stay ranging from 7 to 73 days. The largest contributors to cost for all patients were intensive care stay (30%), hospital room (17%), pharmacy (16%), and surgical intervention (13%).ConclusionsGrade III to IV esophageal anastomotic leaks more than double the cost of an esophagectomy and have a significant cost burden. Focus should be placed on preventative measures to avoid leaks at the time of the index operation.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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