TY - JOUR
T1 - Prevention of retained surgical sponges
T2 - A decision-analytic model predicting relative cost-effectiveness
AU - Regenbogen, Scott E.
AU - Greenberg, Caprice C.
AU - Resch, Stephen C.
AU - Kollengode, Anantha
AU - Cima, Robert R.
AU - Zinner, Michael J.
AU - Gawande, Atul A.
N1 - Funding Information:
S.E.R. was supported by Kirschstein National Research Service Award T32-HS000020 from the Agency for Healthcare Research and Quality. Drs Greenberg and Gawande have received research grant support from SurgiCount Medical, Temecula, CA. The funding agencies were not involved in the conduct, analysis, or composition of this study, and were not given the opportunity to approve or edit the manuscript before submission.
PY - 2009/5
Y1 - 2009/5
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=64449087638&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=64449087638&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2009.01.011
DO - 10.1016/j.surg.2009.01.011
M3 - Article
C2 - 19375612
AN - SCOPUS:64449087638
SN - 0039-6060
VL - 145
SP - 527
EP - 535
JO - Surgery
JF - Surgery
IS - 5
ER -