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

• Published in: Surgery Vol. 145; no. 5; pp. 527 - 535
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2009; Elsevier
• Subjects: 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; Medicine; Prevention; Treatment; Decision making; Surgery; Health economy; Sponge; Models; Decision; Cost efficiency analysis
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2009.01.011

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.