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Impact of Fluorescence Angiography on Clinical and Financial Outcomes in Colorectal Surgery: A Case Matched Series
Deborah Keller*1,2, Sergio Ibarra2, Juan R. Flores2, Eric M. Haas1,2
1Colorectal Surgery, Houston Methodist Hospital, Houston, TX; 2Colorectal Surgical Associates, Houston, TX
Background: Fluorescence angiography (FA) has shown benefit in real-time visualization of tissue perfusion and determining the best transection site in colorectal surgery. The tool’s value is emerging in cases with a high risk of anastomotic leak, such as radiated rectal cancers and low pelvic anastomoses. No prior study has evaluated the short-term clinical and financial outcomes of fluorescence angiography, or its utility in routine colorectal resections. The goal of this study was to evaluate the clinical and cost impact of fluorescence angiographic assessment of the anastomosis in elective colorectal surgery.
Methods: Review of a prospective departmental database was performed for elective laparoscopic colorectal resections that used FA intraoperatively to analyze the proposed transection site before anastomosis. The FA cases were matched on surgeon, demographic, and operative variables to elective laparoscopic colorectal resections performed without FA (control). The main outcome measures were the operative time, and postoperative outcome, and total costs in each group.
Results: 27 patients were evaluated in each group. The groups were well matched in age, gender, comorbidity, indication for operation, and procedure performed. There was no significant difference in mean operative time using FA compared to controls (mean 190.8 (SD 52.5) vs. 161.9 (SD 57.2); p=0.06). Postoperatively, there was no significant difference in length of stay between the FA (mean 3.85 (SD 2.74)) and control groups (3.81 (1.98); p=0.95). Complications were similar, and there were no anastomotic leaks in either group. There was one readmission for abdominal pain in the control group. There were no unplanned reoperations or mortality in either group. There were no significant differences in the mean total costs between the FA and control group, respectively (,553 (SD ,389) vs. ,925 (SD ,516), p= 0.68).
Conclusions: Using FA routinely in elective colorectal resections did not add significantly to the operative time or total costs. With the ability to identify and possibly avert costly anastomotic complications without significantly increasing healthcare utilization, wider utilization of FA should be considered.
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