Cost-Utility Analysis of Percutaneous and Surgery Methods in Extraction of Cardiac Leads Infection

Introduction: Cardiovascular diseases are currently major concern in the world and It is expected that Until 2030, 7 out of 10 deaths in world will be related to cardiovascular diseases. Despite the increase in Pasemaker and ICD implants in recent years, the complications of this devices are increasing. One of the most important complications is the pulsating lead infection. The purpose of this study was to analyze the cost-effectiveness of percutaneous and surgical method in extracting pacemaker leads with Qaly index.Methods: In this cross-sectional article (descriptive-analytical) using the Markov model, for compare the two methods of percutaneous and surgery for infectious lead. Sampling was census and ( sample size for percutaneous included 57 people) and information about utility was extracted by the SAQ questionnaire. A systematic review was performed to calculate utility of the surgical Cost from the perspective of the service provider. data analysis by SPSS software, and TreeAge software was used for Markov modeland and sensitivity analysis .Results: Changes in quality of life score in both intervention were incremental and significant and intervention is the only effective factor in changes in quality of life score (P <0.05). The ICER was 5470.44$.Conclusion: The results of the study show that utility and cost of surgery are higher than the percutaneous method.Sensitivity analysis shows If the cost of surgery increases more than 806.52$ (discount rate of 0.06), the percutaneous method dominates the surgery method.

Surgeon education through a surgical cost feedback system reduces supply cost in endoscopic skull base surgery

OBJECTIVE A large proportion of healthcare expense is operating room (OR) costs. As a means of cost mitigation, several institutions have implemented surgeon education programs to bring awareness about supply costs. This study evaluates the impact of a surgical cost feedback system (surgical receipt) on the supply costs of endoscopic skull base surgery (ESBS) procedures. METHODS The supply costs of each ESBS surgical case were prospectively collected and analyzed before and after the implementation of a nonincentivized, automated, and itemized weekly surgical receipt system between January 2017 and December 2019. Supply cost data collected 15 months prior to intervention were compared with cost data 21 months after implementation of the surgical receipt system. Demographics, surgical details, and OR time were collected retrospectively. RESULTS Of 105 ESBS procedures analyzed, 36 preceded and 69 followed implementation of cost feedback. There were no significant differences in patient age (p = 0.064), sex (p = 0.489), surgical indication (p = 0.389), or OR anesthesia time (p = 0.51) for patients treated before and after implementation. The mean surgical supply cost decreased from $3824.41 to $3010.35 (p = 0.002) after implementation of receipt feedback. Usage of dural sealants (p = 0.043), microfibrillar collagen hemostat (p = 0.007), and oxidized regenerated cellulose hemostat (p < 0.0001) and reconstructive technique (p = 0.031) significantly affected cost. Mediation analysis confirmed that the overall cost reduction was predominantly driven by reduced use of dural sealant; this cost saving exceeded the incremental cost of greater use of packing materials such as microfibrillar collagen hemostat. CONCLUSIONS Education of surgeons regarding surgical supply costs by a surgical receipt feedback system can reduce the supply cost per case of ESBS operations.

STUDY OF THE QUALITY OF LIFE AND COSTS OF PATIENTS ON THE WAITING LIST AGAINST PATIENTS UNDERTAKEN FOR BARIATRIC SURGERY

INTRODUCTION Bariatric surgery is the only effective long-term treatment for patients with morbid obesity, being the deterioration of the quality of life of these patients one of the main reasons for surgery. In this work, we prospectively analyze the impact of health-related quality of life (HRQoL) and comorbidities among patients who underwent bariatric surgery versus those on the waiting list. MATERIAL AND METHODS Between January and December 2017 139 patients (70 operated on and 69 on waiting list) were included in the study, with a 2-year follow-up. Quality of life was measured using the SF-12v2 and IWQoL-Lite questionnaires. Sociodemographic, clinical, and surgical variables were collected. The cost was evaluated through analytical accounting of Diagnosis-Related Groups. RESULTS 12 and 24 months follow-up showed statistically significant improvement in all areas of the HRQoL in the surgical group (p &lt; 0.001). Likewise, this group showed a reduction in comorbidities and healthcare needs. On the other side, those patients on the waiting list showed a deterioration in most of HRQL parameters. The surgical cost is estimated at 3.558€ per patient. CONCLUSIONS Bariatric surgery significantly improves both quality of life and patients’ comorbidities. This, along with the fact that the surgical cost of 3.558€ pays for itself in just two years, could justify a greater investment in these types of procedures as a suitable healthcare strategy.

Comparative study of arthroscopic Bankart repair versus open Latarjet procedure for recurrent shoulder dislocation

Objectives The primary aim of this study was to compare the clinical outcomes of patients undergoing arthroscopic Bankart repair and the open Latarjet procedure for recurrent dislocation of the shoulder. The secondary aims were to assess and compare the surgical cost, patient satisfaction, and complications, including recurrence and infection. Methods We retrospectively compared the clinical outcomes of all consecutive patients undergoing either arthroscopic Bankart repair or the open Latarjet procedure from May 2015 to May 2018 with a minimum 2-year follow-up. Forty-one patients (32 men, 9 women) in the Bankart group and 40 patients (34 men, 6 women) in the Latarjet group were available for the final follow-up. Results There were no statistically significant differences in the demographic parameters or clinical outcomes between the two groups. Functional satisfaction was higher with the Latarjet procedure. Bankart repair had a significantly higher operating cost than the Latarjet procedure. Three patients in the Bankart group and no patients in the Latarjet group developed recurrence. Conclusion Both procedures provided satisfactory clinical outcomes. However, the Latarjet group had a higher rate of functional satisfaction and lower operating cost, and there was a trend toward higher recurrence in the arthroscopic Bankart group.

Standardization of cerebrospinal fluid shunt valves in pediatric hydrocephalus: an analysis of cost, operative time, length of stay, and shunt failure

OBJECTIVECSF shunts are the most common procedures performed in the pediatric neurosurgical population. Despite attempts in multiple studies, a superior shunt valve has never been shown. Because of this, the authors aim was to examine the impact of shunt valve standardization at their institution to determine if there is a difference in surgical cost, operative time, or short-term postoperative shunt failure.METHODSA retrospective analysis at the authors’ institution was performed for all new CSF diversion shunts, as well as shunt revisions requiring a new valve, or a new valve and at least a new proximal or distal catheter over a 1-year period (January 1, 2016, to December 31, 2016). After a period of transition, neurosurgeons were encouraged to use only one type of fixed-differential-pressure valve and one type of programmable valve when performing shunt surgeries. These patients who underwent “standardized” shunt surgery over a 1-year period (January 1, 2018, to December 31, 2018) were then compared to patients in the prestandardization epoch. All patients were followed for a 12-month period after surgery. Demographic information, surgical cost, operative time, and postoperative shunt failure data were collected in all patients in the study.RESULTSThe authors analyzed 87 shunt surgeries in patients prior to standardization and 94 shunt surgeries in patients after standardization. The rate of violation of the standardized shunt valve policy after implementation was 5.3% (5 of 94 procedures). When comparing the prestandardization group to those who received the standardized valve, operative costs were less ($1821.04 vs $1333.75, p = 0.0034). There was no difference in operative times between groups (78 minutes vs 81 minutes, p = 0.5501). There was no difference in total number of shunt failures between the two groups at 12 months after surgery (p = 0.0859). The rate of postoperative infection was consistent with the literature at 8%.CONCLUSIONSIn accordance with quality improvement principles, the reduction of unexplained clinical variance invariably leads to a decrease in cost and, more importantly, increased value. In this study, the implementation of a standardized shunt valve decreased operative cost. There were no differences in postoperative shunt failures at 12 months after surgery and no differences in length of surgery. Standardizing shunt valves in the treatment of pediatric hydrocephalus seems to be cost-effective and safe.

Cost Analysis With Use of Expandable Cage or Cement in Single level Thoracic Vertebrectomy in Metastasis

Study Design: Retrospective case series. Objective: Patient with metastatic cancer frequently require spinal operations for neural decompression and stabilization, most commonly thoracic vertebrectomy with reconstruction. Objective of the study was to assess economic aspects associated with use of cement versus expandable cage in patients with single level thoracic metastatic disease. We also looked at the differences in the clinical, radiological, complications and survival differences to assess non-inferiority of PMMA over cages. Methods: The electronic medical records of patients undergoing single level thoracic vertebrectomy and reconstruction were reviewed. Two groups were made: PMMA and EC. Totals surgical cost, implant costs was analyzed. We also looked at the clinical/ radiological outcome, complication and survival analysis. Results: 96 patients were identified including 70 one-level resections. For 1-level surgeries, Implant costs for use of cement—$75 compared to $9000 for cages. Overall surgical cost was significantly less for PMMA compared to use of EC. No difference was seen in clinical outcome or complication was seen. We noticed significantly better kyphosis correction in the PMMA group. Conclusions: Polymethylmethacrylate cement offers significant cost advantage for reconstruction after thoracic vertebrectomy. It also allows for better kyphosis correction and comparable clinical outcomes and non-inferior to cages.

Propeller Flaps in the Upper Extremity: Arm and Forearm Reconstruction

The propeller flap is an island of skin that is raised on its pedicle (most commonly a single perforator) and can rotate 180 degrees to cover a soft tissue defect. Thanks to these features, the propeller flap brings reliable tissue from outside of the zone of injury while sparing the main vessels of the upper extremity. This technique limits the donor site to the same limb, captures skin characterized by having the same color and texture, does not necessarily need a microvascular anastomosis, and overall reduces the operating time and surgical cost. Our intent here is to present 27 cases with different soft tissue defects of the upper arm and forearm that have been successfully reconstructed using propeller flaps. The surgical technique, with emphasis on the anatomy of the upper arm, is described. In particular, use of a freestyle approach to customize a perforator-based propeller flap to cover defects from small to medium size is detailed. In our experience, the use of a perforator propeller flap in the upper extremity for resurfacing represents both a very reliable and aesthetically pleasant option.