Innovations in medical technology aimed at reducing surgical complications The health economic perspective, clinical application, and optimization

Surgical complications represent a major global challenge, affecting more than one-third of surgical patients and leading to poorer outcomes, reduced quality of life, and increased healthcare costs. Perfusion-related complications, such as anastomotic leakage, are particularly feared in gastrointestinal surgery. This thesis explores the economic burden of such complications, the application of innovative technologies for early detection or prediction, and the evaluation of current diagnostic strategies.
Part I quantifies the economic urgency of reducing complications. Anastomotic leakage substantially increases costs, with large international variations, and results in a fourfold rise in hospital costs within the first postoperative year. Chronic pelvic sepsis following leakage can raise five-year costs to €180,000 per patient.
Part II evaluates novel technologies. A portable endoscopy system demonstrated feasibility for early postoperative detection of anastomotic leakage, forming the basis of the multicentre REAL study. Quantitative fluorescence angiography (ICG-FA) proved promising for assessing intraoperative tissue perfusion, although further validation is required.
Part III critically examines existing strategies. Divergent outcomes from different ICG-FA quantification methods highlight the need for standardization. C-reactive protein showed limited diagnostic value for detecting anastomotic leakage in patients with diverting stomas, reinforcing the role of complementary strategies such as early endoscopy. A meta-analysis of thoracic duct management in esophagectomy revealed no survival benefit of resection or ligation compared with preservation, but a higher risk of complications.
In conclusion, this thesis underscores the clinical and economic impact of surgical complications and the potential of integrating innovative and established diagnostic approaches to reduce their burden for both patients and healthcare systems.