Cost of Pelvic Floor Repair for Faecal Incontinence

Abstract

Background: Pelvic floor repair is often unsuccessful for the treatment of incontinence. Some patients undergo repeated operations, and a few may require a stoma that can result in further operations. Method: We have examined the cost of two forms of pelvic floor repair: post-anal repair (PAR; n = 47) and total pelvic floor repair (TPFR; n = 32). Results: Persistent incontinence, which had an impact on the quality of life, occurred in 23 patients (29%); this was more common after PAR (21 patients; 45%) than after TPFR (2 patients; 6%), but the follow-up period was longer (9.7 years) after PAR than after TPFR (6.6 years), and incontinence tended to deteriorate with time. Twenty-two patients required repeat operations for incontinence (20 patients having 56 re-operations after PAR, and 2 patients who had repeated operation after TPFR). The average number of admissions was 1.92 (PAR 2.42, TPFR 1.18). The total number of operations was 141 (average 1.78), being greater after PAR (104; average 2.12) than after TPFR (37; average 1.15). The total hospital stay was 1,631 days; average 20.64, being longer following PAR (994 days; average 21.1) than after TPFR (637; average 19.9). The total hospital cost based on hospital stay, number of operations, operating time, complexity of surgery and out-patient visits was C∈ 294,216 (average C∈ 3,724), being higher after PAR (C∈ 190,062; average C∈ 4,043) as compared with TPFR (C∈ 104,154; average C∈ 3,254). The extra financial burden was largely borne by 9 individuals, all requiring a stoma, having repeated procedures (more than 2 operations) in whom the average cost was twice that of the index operation. Conclusion: We conclude that end-stage faecal incontinence is a huge burden on hospital budgets, since over time many patients require repeated operations.