Scholarlink

Objective <p>To evaluate the total societal costs of postoperative antibiotic use compared to non-use in patients undergoing surgery for high horseshoe anal fistula (HHAF), based on a randomized controlled trial.</p> Methods <p>We conducted a single-blinded randomized controlled trial in 90 patients with HHAF treated using a standardized loose combined cutting seton (LCCS) procedure at the Department of Colorectal Surgery, China-Japan Friendship Hospital, between January and October 2023. Participants were randomly assigned to either a postoperative Antibiotic group or a No Antibiotic groups. The primary outcome was total societal cost. Clinical outcomes, including wound healing time and early recurrence, were assessed as secondary measures A societal cost-minimization analysis (CMA) was performed, encompassing direct medical costs, outpatient visit costs, and indirect costs due to lost productivity. Patient follow-up was completed by December 2024.</p> Results <p>Ninety patients were randomized equally (45 per group) with comparable baseline data. The Antibiotic group showed significantly higher hospitalization costs (¥13,202 ± 3,054 vs. ¥9,322 ± 1,205; <i>p</i> &lt; 0.001) and longer stays (12.5 ± 5.8 vs. 7.9 ± 2.4 days; <i>p</i> &lt; 0.001), without differences in wound healing (<i>p</i> = 0.490). Regression confirmed that both incision number (β = 1735.18, <i>p</i> = 0.020) and antibiotic use (β = 3287.06, <i>p</i> &lt; 0.001) independently increased cost, with a significant interaction (β = 3641.00, <i>p</i> = 0.010). Antibiotic use also led to more outpatient visits (5.25 vs. 2.75; <i>p</i> = 0.013) and higher total societal costs (¥9,802 vs. ¥7,931; <i>p</i> = 0.014). Sensitivity analyses under multiple scenarios consistently confirmed higher overall costs in the Antibiotic group.</p> Conclusion <p>Routine postoperative antibiotics showed no significant additional clinical benefit in terms of wound healing or recurrence in HHAF patients treated with LCCS, yet significantly increase societal costs and postoperative burdens. A selective, evidence-based approach to antibiotic use should be adopted in the surgical management of complex anal fistulas.</p> Trial registration <p>This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2400093477) on December 5, 2024, after the enrollment of participants began in January 2023. The retrospective registration is in accordance with the journal’s editorial policy for studies involving healthcare interventions in human participants.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Cost-minimization analysis of postoperative antibiotic use in high horseshoe anal fistula: evidence from a randomized controlled trial in China

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年12月23日

查看全文
  • Xue Li,
  • Yicheng Cheng,
  • Pengyi Xu,
  • Zijian Wei,
  • Chen Li,
  • CongCong Zhi,
  • Xin Li,
  • Ye Yuan,
  • Lihua Zheng

摘要

Objective

To evaluate the total societal costs of postoperative antibiotic use compared to non-use in patients undergoing surgery for high horseshoe anal fistula (HHAF), based on a randomized controlled trial.

Methods

We conducted a single-blinded randomized controlled trial in 90 patients with HHAF treated using a standardized loose combined cutting seton (LCCS) procedure at the Department of Colorectal Surgery, China-Japan Friendship Hospital, between January and October 2023. Participants were randomly assigned to either a postoperative Antibiotic group or a No Antibiotic groups. The primary outcome was total societal cost. Clinical outcomes, including wound healing time and early recurrence, were assessed as secondary measures A societal cost-minimization analysis (CMA) was performed, encompassing direct medical costs, outpatient visit costs, and indirect costs due to lost productivity. Patient follow-up was completed by December 2024.

Results

Ninety patients were randomized equally (45 per group) with comparable baseline data. The Antibiotic group showed significantly higher hospitalization costs (¥13,202 ± 3,054 vs. ¥9,322 ± 1,205; p < 0.001) and longer stays (12.5 ± 5.8 vs. 7.9 ± 2.4 days; p < 0.001), without differences in wound healing (p = 0.490). Regression confirmed that both incision number (β = 1735.18, p = 0.020) and antibiotic use (β = 3287.06, p < 0.001) independently increased cost, with a significant interaction (β = 3641.00, p = 0.010). Antibiotic use also led to more outpatient visits (5.25 vs. 2.75; p = 0.013) and higher total societal costs (¥9,802 vs. ¥7,931; p = 0.014). Sensitivity analyses under multiple scenarios consistently confirmed higher overall costs in the Antibiotic group.

Conclusion

Routine postoperative antibiotics showed no significant additional clinical benefit in terms of wound healing or recurrence in HHAF patients treated with LCCS, yet significantly increase societal costs and postoperative burdens. A selective, evidence-based approach to antibiotic use should be adopted in the surgical management of complex anal fistulas.

Trial registration

This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2400093477) on December 5, 2024, after the enrollment of participants began in January 2023. The retrospective registration is in accordance with the journal’s editorial policy for studies involving healthcare interventions in human participants.