BACKGROUND: Patients undergoing colectomy for ulcerative colitis (UC) may experience complications associated with reduced quality of life (QoL), and maybe a considerable economic burden to healthcare systems. Appreciation of these burdens is important to evaluate the cost effectiveness of newer interventions for UC vs. colectomy.
AIM: To identify data representing resource utilisation or costs of complications arising from colorectal procedures in patients with UC, and data representing patient QoL, as reported by health state utility values (HSUVs).
METHODS: Embase, MEDLINE and The Cochrane Library were searched for studies (1995-2014) reporting resource use/costs of surgical complications, and HSUVs data in adult patients with UC, undergoing colorectal procedures. Conference proceedings (January 2011-January 2014) were hand-searched.
RESULTS: Twelve studies reported resource use/costs, and three reported HSUVs data in patients with UC experiencing surgical complications. Additional mean costs of postoperative complications ranged from $18 650/patient with complications at a 6-month follow-up (46% incidence) to $34 714/patient with complications over a 5-year period (49% incidence). Pouchitis, pouch failure and small bowel obstruction carried the greatest burden. Marked reductions in HSUVs were observed for patients with UC experiencing surgical complications, vs. patients with UC in a remission state.
CONCLUSIONS: There is a paucity of well reported studies on resource use/cost, and QoL burden of surgical complications in patients with UC. However, surgical complications represent a substantial burden both in terms of cost and of quality of life, with reoperations, physician fees, additional in-patient hospital stays and infertility treatment being the main cost drivers.
Aderenze addominali sono associati ad un aumento complicanze post-operatorie, i costi e il carico di lavoro. Abbiamo effettuato una revisione sistematica con raggruppamento statistico per stimare il tasso di formazione, la distribuzione e la gravità delle aderenze post-operatorie in pazienti sottoposti a chirurgia addominale. Una ricerca della letteratura è stata effettuata per tutti gli articoli di dichiarazione riguardanti l'incidenza, la distribuzione e la gravità delle aderenze tra il gennaio 1990 e il luglio 2011. Venticinque articoli soddisfacevano i criteri di inclusione. Il tasso di formazione media pesata di aderenze dopo un intervento chirurgico addominale è stata del 54% (intervallo di confidenza del 95% [CI] 40-68%), e del 66% (95% CI 38-94%) dopo chirurgia gastrointestinale, 51% (95% CI 40-63%) dopo l'ostetrica e chirurgia ginecologica e il 22% (95% CI 7-38%) dopo chirurgia urologica. Il punteggio di gravità media complessiva era di 1,11 ± 0,98 secondo la Laparoscopia Operativa Study Group classificazione. La chirurgia laparoscopica ha ridotto il tasso di formazione di aderenze del 25% e diminuisce il punteggio di gravità adesione (laparoscopica; 0,36 ± 0,69 vs aperta; 2,14 ± 0,84) per la chirurgia gastrointestinale. I nostri risultati dimostrano che l'incidenza e la gravità delle aderenze addominali varia tra specialità e procedure chirurgiche. Una maggiore consapevolezza delle aderenze può aiutare a identificare i meccanismi di base della formazione di aderenze e di nuovi approcci terapeutici, ma anche di migliorare il processo di consenso chirurgico.
Patients undergoing colectomy for ulcerative colitis (UC) may experience complications associated with reduced quality of life (QoL), and maybe a considerable economic burden to healthcare systems. Appreciation of these burdens is important to evaluate the cost effectiveness of newer interventions for UC vs. colectomy.
AIM:
To identify data representing resource utilisation or costs of complications arising from colorectal procedures in patients with UC, and data representing patient QoL, as reported by health state utility values (HSUVs).
METHODS:
Embase, MEDLINE and The Cochrane Library were searched for studies (1995-2014) reporting resource use/costs of surgical complications, and HSUVs data in adult patients with UC, undergoing colorectal procedures. Conference proceedings (January 2011-January 2014) were hand-searched.
RESULTS:
Twelve studies reported resource use/costs, and three reported HSUVs data in patients with UC experiencing surgical complications. Additional mean costs of postoperative complications ranged from $18 650/patient with complications at a 6-month follow-up (46% incidence) to $34 714/patient with complications over a 5-year period (49% incidence). Pouchitis, pouch failure and small bowel obstruction carried the greatest burden. Marked reductions in HSUVs were observed for patients with UC experiencing surgical complications, vs. patients with UC in a remission state.
CONCLUSIONS:
There is a paucity of well reported studies on resource use/cost, and QoL burden of surgical complications in patients with UC. However, surgical complications represent a substantial burden both in terms of cost and of quality of life, with reoperations, physician fees, additional in-patient hospital stays and infertility treatment being the main cost drivers.
