COST REDUCTION BY DECONTAMINATION TO PREV ENT ANASTOMOTIC LEAKAGE FOLLOWING TOTAL GASTRECTOMY

The aim of this study was to examine the effect of decontamination as compared to placebo medication on post-gastrectomy treatment costs. Th e results of a prospective double-blind placebo-controlled multicenter trial indicate that perioperative i.v. prophylaxis with cefotaxim and topical decontamination with polymyxin B, tobramycin, vancomycin and amphotericin B from the day before surgery until the 7th postoperative day is most effective in the prevention of esophagojejunal anastomoti c leakage following total gastrectomy. For the cost analysis, only pat ients who had been decontaminated according to the study protocol (n = 90) were compared to the non-decontaminated patients (n = 103). The e sophagojejunal leakage rate was 10.6 % in placebo patients (n = 103) a nd could be reduced significantly to 1.1% in decontaminated patients ( n = 90, P = 0.0061; two-tailed Fisher's exact test). There was only on e asymptomatic leakage detected on Gastrografin swallow. The pulmonary infection (P = 0.0173) and overall complication rates (p = 0.0238) we re significantly reduced in the decontamination group as well. During the observation period, 9 (8.7 %) patients in the placebo group and 3 (3.3 %) in the decontaminated group died (P = n. s.). Patients were fo llowed up for the initial 42 postoperative days and treatment costs we re calculated for this time period only. The parameters compiled in th e study pertaining to use of medical resources formed the basis for th e determination of the postoperative treatment costs. These were the c osts for decontaminating drugs, intravenous antibiotics, reoperations and non-surgical reinterventions as well as daily treatment costs of t he general ward, the intensive care unit (ICU) and rehabilitation. The average costs per patient in the placebo group amounted to DM 20000 w hile the costs for decontaminated patients were only DM 16200, which w as due to a significantly lower number of patients requiring treatment in the ICU (P = 0.0082), significantly fewer patients requiring i.v. antibiotics (P = 0.0232) and fewer patients with reoperations (P = 0.0 909). The prophylaxis employing decontaminating drugs in the amount of DM 400 lowered post-gastrectomy treatment costs by DM 3800 or 19 %. T he prophylaxis can be recommended, because it lowers morbidity, mortal ity and the costs of total gastrectomy.