{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T04:28:26Z","timestamp":1793593706668,"version":"4.5.0"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Complex cryptoglandular anal fistula is frequently complicated by treatment failure, repeat intervention and ongoing healthcare use. Economic evaluations are limited, rarely incorporate failure\u2010related re\u2010intervention, and seldom distinguish between public and private settings. This study compared 12\u2010month pathway costs for ligation of the inter\u2010sphincteric fistula tract (LIFT), endorectal advancement flap (ERAF), video\u2010assisted anal fistula treatment (VAAFT) and non\u2010definitive seton management in Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A micro\u2010costing analysis was performed using 2023\u201324 Australian public and private hospital data. Costs were calculated from the hospital perspective and incorporated procedures required after treatment failure over 12\u2009months, reflecting pathway costs rather than index procedure costs. Failure rates and re\u2010intervention pathways were derived from a prospectively maintained cohort treated within a single colorectal surgical network (LIFT\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200988; ERAF\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916; VAAFT\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922). Non\u2010definitive seton management was modelled as one, two or four planned operative episodes per year.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Crude observed 12\u2010month treatment failure was similar across definitive procedures (LIFT 36%, ERAF 38%, VAAFT 36%). Pathway costs incorporating treatment failure were AUD 1846\/8858 for LIFT, AUD 2161\/9164 for ERAF, and AUD 1937\u20132968\/8870\u201310\u2009499 for VAAFT in public\/private hospitals, depending on case volume. Seton management cost AUD 871\u20133484\/5050\u201320\u2009200 per year, depending on operative frequency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Incorporating treatment failure narrowed cost differences between definitive sphincter\u2010preserving techniques. Non\u2010definitive seton costs were frequency\u2010dependent. Local case volume, admission pathway, and failure burden should inform service planning and VAAFT adoption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70872","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:26:17Z","timestamp":1784528777000},"page":"3174-3179","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Cost of Imperfection: Recurrence\u2010Adjusted Costs of Sphincter\u2010Preserving Procedures for Complex Anal Fistula in Australia"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6491-4993","authenticated-orcid":false,"given":"Matthew P.","family":"Irwin","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Bankstown\u2010Lidcombe Hospital, South Western Sydney Local Health District  Sydney New South Wales Australia"},{"name":"School of Clinical Medicine University of New South Wales  Sydney New South Wales Australia"},{"name":"School of Medicine University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Bankstown\u2010Lidcombe Hospital, South Western Sydney Local Health District  Sydney New South Wales Australia"},{"name":"School of Clinical Medicine University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine E.","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Bankstown\u2010Lidcombe Hospital, South Western Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8617-2790","authenticated-orcid":false,"given":"Kevin C.","family":"Ooi","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Bankstown\u2010Lidcombe Hospital, South Western Sydney Local Health District  Sydney New South Wales Australia"},{"name":"School of Clinical Medicine University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Bankstown\u2010Lidcombe Hospital, South Western Sydney Local Health District  Sydney New South Wales Australia"},{"name":"School of Clinical Medicine University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.15945"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000002473"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-019-02051-5"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16741"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.50129"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-025-03152-0"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5905-2"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.17451"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16732"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-011-0769-2"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-022-02614-z"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2016.09.082"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2019.09.012"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000003232"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16892"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.70550"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70872","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.70872","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70872","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T04:25:43Z","timestamp":1793593543000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70872"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,19]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/ans.70872"],"URL":"https:\/\/doi.org\/10.1111\/ans.70872","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,19]]},"assertion":[{"value":"2026-04-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}