The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs
Journal of Surgery
Volume 3, Issue 2, April 2015, Pages: 12-17
Received: Mar. 30, 2015;
Accepted: Apr. 14, 2015;
Published: Apr. 30, 2015
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Jesús Lago Oliver, Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
Salvador Argudo Garijo, Surgery Department, Southeast University Hospital.Arganda del Rey, Madrid, Spain
Mauricio Burneo Estéves, Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
Marta Cuadrado Ayuso, Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain; Basic Health Sciences Department, University Rey Juan Carlos, Madrid, Spain
Fernando Turégano Fuentes, Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
Araceli Casado Gómez, Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
Objective: To analyse hospital costs in the pre-, and intra- and post-operative periods associated with patients undergoing rectal resection with anastomosis, comparing the costs per patient with and without the use of fibrin-based biological adhesive(Tissucol Duo®). Methods: The cost analysis was designed with a subsample of 37 patients who underwent rectal anastomosis in a randomised, single-blind, controlled, parallel comparison between two groups, to evaluate the effectiveness of fibrin-based biological adhesive used to prevent anastomotic leakage. The total costs included diagnostic tests, laboratory tests, hospital stay, adhesive cost, surgery, reintervention and drug treatment. Results: The patients had a mean age of 64.33 years, with a higher proportion of men (62.2%). The study groups were homogeneous and comparable. The average total cost in the group with biological adhesive was€ 10,304.84 compared to € 17,845.12 in the group without biological adhesive. Significant differences were found in the average cost of reintervention between groups: € 119.76 with adhesive vs. € 639.20 for the control group. Conclusions: The total cost decreased by 42% in the group in which a biological adhesive was applied compared to the group in which the adhesive was not applied. This percentage represented a difference of € 7,540.28 in the total average cost per patient.
Jesús Lago Oliver,
Salvador Argudo Garijo,
Mauricio Burneo Estéves,
Marta Cuadrado Ayuso,
Fernando Turégano Fuentes,
Araceli Casado Gómez,
The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs, Journal of Surgery.
Vol. 3, No. 2,
2015, pp. 12-17.
Lago Oliver J, Arjona Medina I, Martín García-Almenta E, et al. “Use of fibrin based biological glues in the prevention of anastomotic leaks in the high risk digestive tract: preliminary results of the multicentre, prospective, randomised, controlled, and simple blind phase iv clinical trial”: 1Protissucol001. Cir Esp. 2012;90:647-655.
Kaidar-Person O, Rosenthal RJ, Wexner SD, et al. “Compression anastomosis: history and clinical considerations.”Am J Surg 2008;195:818-826.
Midura EF, Hanseman D, Davis BR, et al. “Risk factors and consequences of anastomotic leak after colectomy: a national analysis”. Dis Colon Rectum 2015;58(3):333-338
Snijders HS, Bakker IS, Dekker JW, et al. “High 1-year complication rate after anterior resection for rectal cancer”. J Gastrointest Surg 2014;18(4):831-838
European Medicines Agency. “Questions and answers on the review of the fibrin sealants Tisseel, Tissucol, Artiss and Beriplast P (and associated names) given by spray application”. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Fibrin_sealants_31/WC500136248.pdf
Avalos-González J, Portilla-de Buen E, Leal-Cortés CA, et al. “Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant”. World J Gastroenterol 2010;16:2793–2800.
Toro A, Mannino M, Reale G, et al. “TachoSil use in abdominal surgery: a review”. J Blood Med 2011;2:31–36.
Vakalopoulos KA, Daams F, Wu Z, et al. “Tissue adhesives in gastrointestinal anastomosis: a systematic review”. J Surg Res 2013;180:290-300.
Hiura Y, Takiguchi S, Yamamoto K, et al. “Use of fibrin glue sealant with polyglycolic acid sheets to prevent pancreatic fistula formation after laparoscopic-assisted gastrectomy”. Surg Today 2013;43:527-533.
Soga K, Ochiai T, Sonoyama T, et al. “Risk factors for postoperative pancreatic fistula in distal pancreatectomy”. Hepatogastroenterology 2011;58:1372-1376.
Ikegami T, Maeda T, Kayashima H, et al. “Soft coagulation, polyglycolic acid felt, and fibrin glue for prevention of pancreatic fistula after distal pancreatectomy”. Surg Today 2011;41:1224-1227.
Mita K, Ito H, Fukumoto M, et al. “A fibrin glue sealing method for the prevention of pancreatic fistula following distal pancreatectomy”. Hepatogastroenterology 2011;58:604-608.
Ussat S, Lodes U, Wex C, et al. “Successful closure of a postoperative esophagobronchial fistula following esophageal resection using fibrin glue”. Dtsch Med Wochenschr 2013;138:1406-1409.
Dhua AK, Ratan SK, Aggarwal SK. “Chylothorax after Primary Repair of Esophageal Atresia with Tracheo-esophageal Fistula: Successful Management by Biological Fibrin Glue”. APSP J Case Rep 2012;3:16.
Ramón Rábago L, Moral I, Delgado M, et al. “Tratamiento endoscópico de fístulas gastrointestinales con un pegamento biológico tisular”. [Endoscopic treatment of gastrointestinal fistulas with biological tissue glue.] Gastroenterol Hepatol 2006;29:390-396.
TissucolDuo®. Summary of Products Characteristics. Available at: http://www.aemps.gob.es/cima/pdfs/es/ft/60427/FT_60427.pdf
General Council of Official Pharmaceuticals Colleges. Medicinal Products database. Bot plus web. Available at: www.portalfarma.com
Oblikue consulting. National health cost database. Available at: www.oblikue.com
Ashraf SQ, Burns EM, Jani A, et al. “The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?”Colorectal Dis 2013;15:190-198.
Kang CY, Halabi WJ, Chaudhry OO, et al. “Risk factors for anastomotic leakage after anterior resection for rectal cancer”. JAMA Surg 2013;148:65-71.
Manta R, Magno L, Conigliaro R, et al. “Endoscopic repair of post-surgical gastrointestinal complications”. Dig Liver Dis 2013;45:879-885.
Mäkelä JT, Kiviniemi H, Laitinen S. “Risk Factors for Anastomotic Leakage After Left-Sided Colorectal Resection With Rectal Anastomosis”. Dis Colon Rectum 2003;46:653-660.
Frye J, Bokey EL, Chapuis PH, et al. “Anastomotic leakage after resection of colorectal cancer generates prodigious use of hospital resources”. Colorectal Dis 2009;11:917-920.
Testi W, Vernillo R, Spagnulo M et al. “Endoscopic treatment of intestinal anastomotic leakage in low anterior resection of the rectum by using fibrin adhesive. Our experience”.Minerva Chir 2002;57:683-688.