Abstract
BackgroundLittle is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries.MethodsMEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC) checklist.ResultsSixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered.DiscussionEL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure.ConclusionsEmergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to this type of surgery is to be pursued as a global health target.Trial registrationPROSPERO registration no. 42015027210.
Highlights
Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world
The literature demonstrates wide variation in quality and outcomes between different healthcare providers even within a single healthcare system (NELA project team 2015; Murray et al 2012), and it is likely that there is substantial variation between institutions in the costs incurred. National measurement programmes, such as National Emergency Laparotomy Audit (NELA) in the UK and the National Surgical Quality Improvement Program (NSQIP) in the USA, provide a unique opportunity for health economic analyses to be undertaken using data capture mechanisms embedded within health services
The addition of Health Related Quality of Life (HRQOL) measures to the datasets would provide the opportunity for societal impact to be better assessed and for the variation in costs and cost effectiveness between providers to be highlighted
Summary
Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. In 2015, The Lancet Commission set a target that by 2030, 80% of the global population should have access to facilities able to safely provide EL within 2 h (Meara et al 2016). Is it a common procedure, it is associated with substantial mortality, reported variably between 11 and 15% (NELA project team 2015; Shapter et al 2012). Patients undergoing EL suffer significant morbidity (Howes et al 2015) with up to 25% still remaining in hospital 20 days after surgery (NELA project team 2015)
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