Factors affecting cost and length of stay associated with the ileal pouch-anal anastomosis.

PURPOSE: The purpose of this study was to evaluate the costs associated with the ileal pouch-anal anastomosis procedure and identify those factors that most affected or determined such costs. Specifically evaluated were the costs, complication rates, and length of stay associated with the ileal pouch-anal anastomosis done as a one-stage, two-stage, two-stage modified, or three-stage procedure. METHODS: Costs from the hospital accounting database and clinical data from retrospective chart review of 135 ileal pouch-anal anastomosis patients from a ten-year period were compiled. Overall costs and length of stay (the sum of all hospitalizations for all surgeries and any related complications) for each group were compared by analysis of variance. Linear regression was used to compute net costs and length of stay excluding contributions from other relevant factors such as number of operative stages, complications, demographics, and nonelective operations. RESULTS: The average overall cost and length of stay of the ileal pouch-anal anastomosis ranged from a low of $12,738 and 13.5 days for the one-stage procedure to a high of $32,758 and 23.9 days for the three-stage pathway. Overall costs, length of stay, and incidence of complications increased with the number of operations necessary to complete the ileal pouch-anal anastomosis. This pattern of increased costs and length of stay with the greater number of stages persisted even after demographic and preoperative characteristics were controlled for in the analyses. The occurrence of a complication added an average of $9,304 (P < 0.0001) and 7.4 days to the procedure (P = 0.0002), whereas an urgent presentation added an average of $5,258 (P = 0.15) and 6.1 days (P = 0.04). CONCLUSIONS: The two most definitive determinants of cost and length of stay after ileal pouch-anal anastomosis are complications and number of operative stages used to complete the operation. Elective ileal pouch-anal anastomosis operations done in the fewest stages with the least complications provide the least costly result and the shortest hospital stay. For patients with severe disease, the two-stage modified pathway (total abdominal colectomy followed by pouch creation without a protecting ileostomy) appears to have fewer complications, lower costs, and a shorter length of stay than the traditional three-stage pathway.