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Prevention of retained surgical sponges: A decision-analytic model predicting relative cost-effectiveness

Regenbogen, Scott E., MD, MPH ; Greenberg, Caprice C., MD, MPH ; Resch, Stephen C., PhD, MPH ; Kollengode, Anantha, PhD, MBA ; Cima, Robert R., MD, MA, FACS ; Zinner, Michael J., MD, FACS ; Gawande, Atul A., MD, MPH, FACS

Surgery, 2009-05, Vol.145 (5), p.527-535 [Periódico revisado por pares]

New York, NY: Mosby, Inc

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Título:
Prevention of retained surgical sponges: A decision-analytic model predicting relative cost-effectiveness
Autor: Regenbogen, Scott E., MD, MPH ; Greenberg, Caprice C., MD, MPH ; Resch, Stephen C., PhD, MPH ; Kollengode, Anantha, PhD, MBA ; Cima, Robert R., MD, MA, FACS ; Zinner, Michael J., MD, FACS ; Gawande, Atul A., MD, MPH, FACS
Assuntos: Biological and medical sciences ; Contrast Media ; Cost-Benefit Analysis ; Decision Support Techniques ; Foreign Bodies - economics ; Foreign Bodies - epidemiology ; Foreign Bodies - prevention & control ; General aspects ; Humans ; Incidence ; Intraoperative Complications ; Isotope Labeling ; Medical sciences ; Models, Economic ; Predictive Value of Tests ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Sensitivity and Specificity ; Surgery ; Surgical Sponges - adverse effects ; Surgical Sponges - economics
É parte de: Surgery, 2009-05, Vol.145 (5), p.527-535
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: Background New technologies are available to reduce or prevent retained surgical sponges (RSS), but their relative cost effectiveness are unknown. We developed an empirically calibrated decision-analytic model comparing standard counting against alternative strategies: universal or selective x-ray, bar-coded sponges (BCS), and radiofrequency-tagged (RF) sponges. Methods Key model parameters were obtained from field observations during a randomized-controlled BCS trial (n = 298), an observational study of RSS (n = 191,168), and clinical experience with BCS (n ∼ 60,000). Because no comparable data exist for RF, we modeled its performance under 2 alternative assumptions. Only incremental sponge-tracking costs, excluding those common to all strategies, were considered. Main outcomes were RSS incidence and cost-effectiveness ratios for each strategy, from the institutional decision maker's perspective. Results Standard counting detects 82% of RSS. Bar coding prevents ≥97.5% for an additional $95,000 per RSS averted. If RF were as effective as bar coding, it would cost $720,000 per additional RSS averted (versus standard counting). Universal and selective x-rays for high-risk operations are more costly, but less effective than BCS—$1.1 to 1.4 million per RSS event prevented. In sensitivity analyses, results were robust over the plausible range of effectiveness assumptions, but sensitive to cost. Conclusion Using currently available data, this analysis provides a useful model for comparing the relative cost effectiveness of existing sponge-tracking strategies. Selecting the best method for an institution depends on its priorities: ease of use, cost reduction, or ensuring RSS are truly “never events.” Given medical and liability costs of >$200,000 per incident, novel technologies can substantially reduce the incidence of RSS at an acceptable cost.
Editor: New York, NY: Mosby, Inc
Idioma: Inglês

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Prevention of retained surgical sponges: A decision-analytic model predicting relative cost-effectiveness

Regenbogen, Scott E., MD, MPH ; Greenberg, Caprice C., MD, MPH ; Resch, Stephen C., PhD, MPH ; Kollengode, Anantha, PhD, MBA ; Cima, Robert R., MD, MA, FACS ; Zinner, Michael J., MD, FACS ; Gawande, Atul A., MD, MPH, FACS

New York, NY: Mosby, Inc

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