Clinical and economic burden of colorectal and bariatric anastomotic leaks



Anastomotic leaks cause a significant clinical and economic burden on patients undergoing bariatric and colorectal surgeries. Current literature shows a wide variation in incidence of anastomotic leaks and a significant gap in associated economic metrics. This analysis utilized claims data to quantify the full episode-of-care cost burden of leaks following colorectal and bariatric surgeries.


Medicare Fee-for-Service and commercial claims data from a large U.S.-based health plan were queried for cost and utilization of members that underwent bariatric and colorectal surgical procedures between January 1, 2013 and August 31, 2015. Outcomes were collected for members with anastomotic leaks versus those without leaks during the initial hospital stay (index) and within 30 days of the procedure. These outcomes included leak frequency, payer reimbursement, and length of stay (LOS).


The colorectal Medicare analysis identified 239,350 patients undergoing colorectal surgery. For patients with a leak compared to those without, index admission costs were $30,670 greater ($48,982 vs. $18,312; p < 0.0001) and the index LOS was 12 days longer (19 vs. 7 days; p < 0.0001). This finding was similar for the bariatric patients (n = 62,292) where cost was $30,885 higher ($43,918 vs. $13,033; p < 0.0001) and LOS was 15 days longer (17 vs. 2 days; p < 0.0001). Furthermore, readmissions and associated costs were also substantially higher for those with an index leak. The commercial analysis of both the bariatric and colorectal populations trended similarly to the Medicare population in regards to all outcomes measured.


Patients experiencing anastomotic leaks during and after bariatric and colorectal surgery have significantly higher costs and longer LOS both at the initial stay and within 30 days of the procedure. It is important that providers and hospitals understand the economic consequences of these procedures and implement technologies and techniques to prevent/reduce anastomotic leaks.

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The authors would like thank Mr. Keith Needham, Manager with Baker Tilly, and Mr. Christopher Adams, MPH, Senior Consultant with Baker Tilly for their analytical support on this important piece of economic research.


Olympus Corporation of the Americas, Central Valley, PA.

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Correspondence to David Gregory.

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Dr. Lee is a consultant for Olympus Corporation of the Americas, Ms. Cool has no conflict of interest or financial ties to disclose. Mr. Gregory is a partner with Baker Tilly and Baker Tilly receives management consulting fees from Olympus for various data analytic support activities.

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Coding for anastomotic leak, bariatric and colorectal procedures

ICD-9 code Description
ICD-9: anastomotic leak case identification codes
 041.04 Streptococcus infection in conditions classified elsewhere and of unspecified site, Group D [Enterococcus]
 041.49 Other and unspecified Escherichia coli [E. coli] unspecified site exclude?
 041.85 Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms unspecified site exclude?
 539.81 Infection due to other bariatric procedure
 567.0 Peritonitis and retroperitoneal infections: peritonitis in infectious diseases classified elsewhere
 567.21 Other suppurative peritonitis: peritonitis (acute) generalized
 567.22 Other suppurative peritonitis: peritoneal abscess
 569.5 Abscess of intestine
 569.81 Fistula of intestine, excluding rectum and anus
 569.83 Perforation of intestine
 790.7 Bacterimia
 998.31 Disruption of internal operation (surgical) wound
 998.59 Other postoperative infection
 998.6 Persistent postoperative fistula
 038.4 Septicemia due to other gram-negative organisms
 038.8 Other specified septicemia
 038.9 Unspecified septicemia
 54.11 Exploratory laparotomy (procedure code)
 54.12 Reopening of recent laparotomy site (procedure code)
 54.0 Incision of abdominal wall (procedure code)
 54.19 Other laparotomy (procedure code)
 54.91 Percutaneous abdominal drainage (procedure code)
ICD-9: bariatric procedure codes
 43.82 Laparoscopic sleeve gastrectomy
 43.89 Open and other partial gastrectomy
 44.31 High gastric bypass
 44.38 Laparoscopic gastroenterostomy
 44.39 Other gastroenterostomy without gastrectomy
 43.6 Partial gastrectomy with anastomosis to duodenum
 43.7 Partial gastrectomy with anastomosis to jejunum
 44.5 Revision of gastric anastomosis
ICD-9: colorectal procedure codes
 17.31 Laparoscopic multiple segmentation of large intestine
 17.32 Laparoscopic cecectomy
 17.33 Laparoscopic right hemicolectomy
 17.34 Laparoscopic resection of transverse colon
 17.35 Laparoscopic left hemicolectomy
 17.36 Laparoscopic sigmoidectomy
 17.39 Other laparoscopic partial excision of large intestine
 45.71 Open and multiple segmentation resection of large intestine
 45.72 Open and other cecetomy
 45.73 Open and right hemicolectomy
 45.74 Open and other transverse colon
 45.75 Open and left hemicolectomy
 45.76 Open and other sigmoidectomy
 45.79 Other and unspecified partial excision of large intestine
 45.81 Laparoscopic total intra-abdominal colectomy
 45.82 Open total intra-abdominal colectomy
 45.83 Other and unspecified total intra-abdominal colectomy
 45.9 Intestinal anastomosis, not specified
 45.91 Small to small intestinal anastomosis
 45.92 Anastomosis to rectal
 45.93 Other small to large intestinal anastomosis
 45.94 Large to large intestinal anastomosis
 45.95 Anastomosis to anus
 46.94 Revision of anastomosis of large intestine

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Lee, S.W., Gregory, D. & Cool, C.L. Clinical and economic burden of colorectal and bariatric anastomotic leaks. Surg Endosc 34, 4374–4381 (2020).

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  • Anastomotic leaks
  • Intraoperative endoscopy
  • Cost analysis