[The surgeon as a cost factor. Cost analysis exemplified by surgical treatment of rectal carcinoma]

Besides quality, costs play an increasingly important role. For rectal carcinoma, the cost of the surgical treatment of the disease (including after-care) was analysed under variable clinical conditions.

Eleven patients (eight men, three women, median age 57 years) with curative resection of rectal carcinoma between 1991 and 1995 were selected: Five patients with an uneventful course remaining recurrence-free, three patients who developed an anastomotic leakage and three patients with locoregional recurrence during their further course. In three patients, adjuvant radiochemotherapy was performed after resection of the primary tumor. For each patient, costs from the first postoperative day until the end of an assumed after-care of 5 years' duration were analysed.

Costs for the postoperative period of the primary treatment ranged between 3.162 DM and 149.988 DM, in case of development of an anastomotic leakage between 14.699 DM and 149.988 DM. Adjuvant radiochemotherapy increased costs by 12.265 DM up to 23.259 DM, locoregional recurrence caused additional costs between 9.461 DM and 27.301 DM. Cost group analysis showed the costs for nursing care to be the highest (30% of total costs), followed by the expense for drugs and medication. Total costs of treatment ranged from 7.361 DM to 160.833 DM.

Costs as well as the patient's prognosis depend to a great extent on the quality of the procedure and consequently on the individual operating surgeon. A complicated course is associated with a considerable increase in costs. A complete cost analysis of rectal carcinoma has to include the cost of a potential locoregional recurrence which would lead to the additional prolonged after-care for these patients.