Open AccessCost minimisation analysis of change in closure technique of midline incisions
Author(s) -
Israelsson L. A.,
Wimo A.
Publication year - 2000
Publication title -
european journal of surgery
Language(s) - English
Resource type - Journals
eISSN - 1741-9271
pISSN - 1102-4151
DOI - 10.1080/110241500750008312
Subject(s) - medicine , surgery , incisional hernia , hernia , laparotomy , fibrous joint , minimisation (clinical trials) , hernia repair , wound closure , cost analysis , ventral hernia , general surgery , wound healing , pathology , reliability engineering , engineering
Objective: To make a cost minimisation analysis of incisional hernia repair at a county hospital and extrapolate the results nationally. Setting: County hospital, Sweden. Subjects: 861 patients who underwent midline laparotomy between August 1989 and November 1992. Interventions: In April 1991 surgeons were urged to change their suture technique towards wound closure with a suture length: wound length ratio of at least 4. Main outcome measures: Rate of incisional hernia at 12 months and the number of hernia repairs required with associated costs. Results: The average cost of one hernia repair was SEK 42 643. After the intervention the risk of requiring a hernia repair was reduced by 0.016 for each patient operated on through a midline incision. The cost was reduced by SEK 686 and the cost of an operation 5 minutes longer was SEK 570, so the intervention generated savings of SEK 116 for each patient operated on. A similar reduction on a national level would yield annual savings of SEK 2 107 140, which may be regarded as the annual opportunity cost of an inadequate surgical technique in Sweden. Conclusions: An alteration to the suture technique that reduces the rate of incisional hernia and the number of hernia repairs required is cost effective and generates savings. Copyright © 2000 Taylor and Francis Ltd.