ABSTRACT
BACKGROUND: Colorectal anastomotic leakage causes severe consequences for patients and healthcare system as it will lead to increased consumption of hospital resources and costs. Technological improvements in anastomotic devices could reduce the incidence of leakage and its economic impact. The aim of the present study was to assess if the use of a new powered circular stapler is cost-effective. METHOD: This observational study included patients undergoing left-sided circular stapled colorectal anastomosis between January 2018 and December 2021. Propensity score matching was carried out to create two comparable groups depending on whether the anastomosis was performed using a manual or powered circular device. The rate of anastomotic leakage, its severity, the consumption of hospital resources, and its cost were the main outcome measures. A cost-effectiveness analysis comparing the powered circular stapler versus manual circular staplers was performed. RESULTS: A total of 330 patients were included in the study, 165 in each group. Anastomotic leakage rates were significantly different (p = 0.012): 22 patients (13.3%) in the manual group versus 8 patients (4.8%) in the powered group. The effectiveness of the powered stapler and manual stapler was 98.27% and 93.69%, respectively. The average cost per patient in the powered group was 6238.38, compared with 9700.12 in the manual group. The incremental cost-effectiveness ratio was - 74,915.28 per patient without anastomotic complications. CONCLUSION: The incremental cost of powered circular stapler compared with manual devices was offset by the savings from lowered incidence and cost of management of anastomotic leaks.
Subject(s)
Anastomosis, Surgical , Anastomotic Leak , Colon , Cost-Benefit Analysis , Rectum , Surgical Staplers , Surgical Stapling , Humans , Anastomotic Leak/prevention & control , Anastomotic Leak/economics , Anastomotic Leak/etiology , Female , Surgical Staplers/economics , Male , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/economics , Anastomosis, Surgical/instrumentation , Anastomosis, Surgical/methods , Middle Aged , Aged , Incidence , Surgical Stapling/economics , Surgical Stapling/methods , Surgical Stapling/adverse effects , Surgical Stapling/instrumentation , Colon/surgery , Rectum/surgery , Propensity Score , Adult , Cost-Effectiveness AnalysisABSTRACT
Introducción. El crecimiento continuo del gasto sanitario y la disponibilidad de recursos limitados implican la necesidad de incorporar el análisis de costes a las herramientas de gestión hospitalaria. Objetivo. Obtener la cuenta de explotación de hospitalización de un servicio de neurología y analizar las desviaciones según los costes por proceso. Pacientes y métodos. Es un análisis de costes por proceso en el servicio de neurología de un hospital de referencia de la Comunidad Valenciana (400.000 habitantes). Se utiliza la actividad asistencial de 2008 según la información registrada por el Sistema de Información Económica de la Conselleria de Sanidad, aplicando los métodos ABC y top-down para el cálculo de costes por proceso. Los resultados obtenidos se comparan con las tarifas establecidas para la producción hospitalaria en la Ley de Tasas de la Generalitat Valenciana. Resultados. Para una producción de 1.092 altas hospitalarias, con índice de case-mix de 0,96 y una estancia media de 9,2 días con una casuística de 1,91, los costes de hospitalización fueron de 4.411.643,45 euros, con un coste medio por proceso de 2.111,46 euros. Teniendo en cuenta las tarifas aplicadas, la diferencia entre ingresos y gastos fue de 12.770,39 euros. Los grupos relacionados con el diagnóstico con mayor desviación fueron el 14 (246.392,49 euros), el 533 (90.292,49 euros) y el 15 (55.139,66 euros). Conclusiones. La cuenta de resultados de hospitalización obtenida es negativa, debido a que la estancia media del servicio es superior a lo que cabría esperar, sobre todo en los grupos relacionados con el diagnóstico 14, 533 y 15, que son los más ineficientes (AU)
Introduction. The steady growth of spending on healthcare and the limited availability of resources make it necessary to include cost analysis among the tools used for hospital management. Aims. To obtain the hospitalisation operating statement of a neurology service and to analyse the differences with regard to costs per process. Patients and methods. The study involved an analysis of costs per process in the neurology service of a referral hospital in the Valencian Community (400,000 inhabitants). The data used were those concerning health care activity in 2008 according to the information registered by the Economic Information System of the Valencian Regional Ministry of Health; ABC and top-down methods were applied to calculate the cost per process. The results thus obtained were compared with the fees established for hospital production in the Valencian Regional Governments Law on Fees. Results. For a production of 1092 hospital discharges, with a case-mix index of 0.96 and a mean length of stay of 9.2 days with a case mix of 1.91, hospitalisation costs came to 4,411,643.45 euros, with a mean cost per process of 2,111.46 euros. Taking into account the fees that were applied, the difference between income and expenditure was 12,770.39 euros. The diagnosis-related groups with the greatest difference were numbers 14 (246,392.49 euros), 533 (90,292.49 euros) and 15 (55,139.66 euros). Conclusions. The hospitalisation profit and loss account obtained is negative due to the fact that the mean length of stay in the service is longer than expected, above all in diagnosis-related groups 14, 533 and 15, which are the most inefficient (AU)
