**4. Economic and social burden of CAL**

A CAL almost always implies a considerable increase in direct and indirect surgical procedure costs, which can reach thousands of euros and impact the patient and society [10]. These direct costs are associated with unforeseen medical therapies, the need for re-interventions, the increase in hospital stay, readmission needs [10, 11], and indirect costs usually not accounted for as absenteeism from work and patient loss of quality of life [12].
