Intestinal anastomoses have always been a major problem in digestive surgery. With the use of mechanical suture devices, intestinal anastomosis techniques have improved, allowing standardization of methods and shorter duration of surgical procedures. In addition to shortening the operative time, reduced operating room utilization and length of stay (LOS), health financial strain is also reduced by a lower rate of postoperative complications, quicker recovery and socioprofessional reintegration of patients, and by lowering costs related to treating permanent disabilities such as permanent intestinal stoma. The aim of this study was to estimate the costs of surgical patients with colorectal anastomosis (mechanical or manual suturing) and to identify economically efficient surgical techniques. Material and method: Unicentric 10-year retrospective study in the Bucharest "Prof. Dr. D. Gerota" Emergency Hospital. The costs associated with manually constructed and stapled anastomoses in colorectal surgery were compared. Results: In the group with manual colorectal anastomoses (363 patients) the costs per patient were on average 5190 RON and the average hospital stay 14.95 days. In the group with mechanical colorectal anastomoses (97 patients) the average cost per patient was 5037 RON with an average hospital stay of 11.5 days. Conclusions: The use of mechanical colorectal suture devices resulted in a cost reduction of approximately 150 RON per case and a shortening of average hospital stay by 3.45 days. In addition to these direct benefits, we also list the increase in surgical volume (including the diversification of the range of operations) or indirect effects such as faster socioprofessional reintegration of patients.
Background and aim: After two years of pandemic, planning and budgeting for use of healthcare resources and services is very important. Inpatient COVID-19 hospitalizations costs, regardless of ICD-10 procedure codes, in a Covid-19 support military hospital were analyzed. Methods: The national protocol for the treatment of Covid-19 infection was applied. The costs for laboratory tests, drugs, protection equipment and radiological investigations (imaging techniques such as computed-tomography or radiography), hospitalization days and food were assessed. Results: In our hospital, from August 2020 through June 2021, 241 patients were hospitalized with COVID-19: mean age 59.92±7.8 years, 46% men, 26% military personnel, 11.57±3 days of hospitalization; two third of patients had moderate and severe forms of COVID-19. The main manifestations were: 69% respiratory (18% with severe pneumonia), 3.3% cardiac (2.9% with pulmonary embolism, diagnosed by computed tomography angiography), 28% digestive and 33% psychiatric (most commonly anxiety). The average estimated costs were about 3000€/patient, without significant differences based on disease severity. Equipment costs were 2 times higher than for drugs and 3 times than for laboratory tests. Conclusions: In a Covid-19 support military hospital that cared for patients with predominantly moderate forms of COVID-19, the costs for equipment were much higher than those for treatment. New criteria for hospitalization of these forms of COVID-19 deserve to be analyzed in order to avoid useless costs.
