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An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae
Author(s) -
Fisher O. M.,
Raptis D. A.,
Vetter D.,
Novak A.,
Dindo D.,
Hahnloser D.,
Clavien P.A.,
Nocito A.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12888
Subject(s) - medicine , anal fistula , fistula , surgery , anal sphincter , cost analysis , engineering , reliability engineering
Aim The study aimed to compare the rate of success and cost of anal fistula plug ( AFP ) insertion and endorectal advancement flap ( ERAF ) for anal fistula. Method Patients receiving an AFP or ERAF for a complex single fistula tract, defined as involving more than a third of the longitudinal length of of the anal sphincter, were registered in a prospective database. A regression analysis was performed of factors predicting recurrence and contributing to cost. Results Seventy‐one patients ( AFP 31, ERAF 40) were analysed. Twelve (39%) recurrences occurred in the AFP and 17 (43%) in the ERAF group ( P = 1.00). The median length of stay was 1.23 and 2.0 days ( P < 0.001), respectively, and the mean cost of treatment was €5439 ± €2629 and €7957 ± €5905 ( P = 0.021), respectively. On multivariable analysis, postoperative complications, underlying inflammatory bowel disease and fistula recurring after previous treatment were independent predictors of de novo recurrence. It also showed that length of hospital stay ≤ 1 day to be the most significant independent contributor to lower cost ( P = 0.023). Conclusion Anal fistula plug and ERAF were equally effective in treating fistula‐in‐ano, but AFP has a mean cost saving of €2518 per procedure compared with ERAF . The higher cost for ERAF is due to a longer median length of stay.