Abstract
Background
Use of ultrasonic shears is currently the standard for advanced laparoscopic digestive surgery. The costs of medical care continue to increase, yet the amount of evidence-based information on cost differences in reusable and single-use equipment is scarce.
Methods
All bariatric laparoscopic cases in our division that required the use of ultrasonic shears were observed during a 7-month period. The reusable and single-use scalpels were alternated weekly. Associated expenses (replacements, cleaning, sterilization), blood loss, complications, and ease-of-use were assessed. The total cost and cost per case for the two types of scalpels were calculated and compared.
Results
Eighty-five cases with both the single-use and reusable scalpels were evaluated. Both groups of cases were comparable in type of surgeries and patient demographics. No significant difference in operation time (reusable, 156 ± 15 min; single-use, 174 ± 15 min; p = 0.34) or ease-of-use was noted. The equipment failure rate (one replacement each), complications, and estimated blood loss (reusable, 63 ± 11 mL; single-use, 83 ± 12 mL; p = 0.06) were similar. A total cost saving of $15,163 resulted from the use and processing of the reusable equipment. Using the reusable shears for 85 cases, the cost-per-case saving was $196.40.
Conclusions
The reusable scalpel had a cost saving over single-use scalpel that increased with the number of cases. The reusable scalpel resulted in significant cost savings without impact on complication rate and ease-of-use.
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References
Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: how much, and who’s paying? Health AFF (Millwood). 2004;Suppl W3:219–26.
Mason EE. Methods for voluntary weight loss and control. A National Institutes of Health Technology Assessment Conference. Obes Surg. 1992;2:275–6, (summarized by Mason EE).
Balsinger BM, Murr MM, Poggio JL, et al. Bariatric surgery. Med Clin North Am. 2000;84:477–89.
Livingston EH. Hospital costs associated with bariatric procedures in the United States. Am J Surg. 2005;190:816–20.
Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass. Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.
Nguyen NT, Goldman CD, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;214:279–89.
Reidenbach HD, Buess G. Ancillary technology: electrocautery thermocoagulation and laser. In: Cuschieri A, Buess G, Perrisat L, editors. Operative manual of endoscopic surgery. Berlin: Springer; 1994. p. 46–60.
Kinoshita T, Kanehira E, Omura K, et al. Experimental study on heat production by a 23.5-kHz ultrasonically activated device for endoscopic surgery. Surg Endosc. 1999;13:621–5.
Hensman C, Baty D, Willis RG, et al. Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment: an in-vitro study. Surg Endosc. 1998;12:1017–9.
Holub Z, Jabor A, Kliment L, et al. Laparoscopic lymph node dissection using ultrasonically activated shears: comparison with electrosurgery. J Laparoendosc Adv Surg Tech. 2002;12:175–80.
Amaral JF. Laparoscopic cholecystectomy in 200 consecutive patients using ultrasonically activated scalpel. Surg Laparosc Endosc. 1995;4:255–62.
Stringer NH. Laparoscopic myomectomy with harmonic scalpel: a review of 25 cases. J Gynecol Surg. 1994;10:245–341.
Schaer GN, Koechli OR, Haller U. Single-use versus reusable laparoscopic surgical instruments: a comparative cost analysis. Am J Obstet Gynecol. 1995;173:1812–5.
Favero MS, Bond WW. Chemical disinfection of medical and surgical materials. In: Block SS, editor. Disinfection, sterilization, and preservation. Philadelphia: Lippincott, Williams & Wilkins; 2001. p. 881–917.
Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1995. Infect Control. 1986;7:231–43.
Rutala WA. APIC guideline for selection and use of disinfectants. Association guidelines for professionals in infection control and epidemiology guidelines of 1994, 1995, 1996. Am J Infect Control. 1996;24:313–42.
Kozarek RA, Ratz SL, Merriam LD, et al. Disposable versus reusable biopsy forceps: a prospective evaluation of costs. Gastrointest Endosc. 1996;43:10–3.
Kozarek RA, Raltz SL, Ball TJ, et al. Reuse of disposable sphincterotomes for diagnostic and therapeutic ERCP: a one-year prospective study. Gastrointest Endosc. 1999;49:39–42.
Deprez PH, Horsmans Y, Van Hassel M, et al. Disposable versus reusable biopsy forceps: a prospective cost evaluation. Gastrointest Endosc. 1000;51:262–5.
Grose GJ, Messner RL. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol. 1991;12:289–96.
Bruning LM. Disposable versus reusables in OR practice. Part II. Weighing costs, risks, and wastes. Nurs Manag. 1992;23:721–9.
Emam TA, Cuschiere A. How safe is high-power ultrasonic dissection? Ann Surg. 2005;237:186–91.
Johnson E. Weight-loss surgery demand soars. Indiana: Courier; 2004.
Cottam DR, Nguyen NT, Eid GM, et al. The impact of laparoscopy on bariatric surgery. Surg Endosc. 2005;19:621–7.
Acknowledgment
This work was supported in part from a research grant of Olympus Surgical Corporation.
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Yung, E., Gagner, M., Pomp, A. et al. Cost Comparison of Reusable and Single-Use Ultrasonic Shears for Laparoscopic Bariatric Surgery. OBES SURG 20, 512–518 (2010). https://doi.org/10.1007/s11695-008-9723-4
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DOI: https://doi.org/10.1007/s11695-008-9723-4