The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?

Aim Our aim was to determine the frequency and economic impact of anastomotic leakage (AL) at local and national levels in England. Method 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=23388) 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 28days) 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 pound (SD +/- 965)) were similar to DH reference costs (6319 pound (SD +/- 1830)) after uncomplicated AR. However, there was a significant (P=0.008) discrepancy between the remunerated tariff for AL (9605 pound (SD +/- 6908)) and the actual cost (17220 pound (SD +/- 9642)). AL resulted in an additional annual cost of approximately 1.1million pound to 3.5million pound when extrapolated nationally. Conclusion The estimated economic burden of anastomotic leakage following AR is approximately double that of the remunerated tariff.