Cost minimisation analysis of change in closure technique of midline incisions

• Published in: The European journal of surgery Vol. 166; no. 8; pp. 642 - 646
• Main Authors: Israelsson, L. A., Wimo, A.
• Format: Journal Article
• Language: English
• Published: UK Taylor & Francis, Ltd 01.08.2000; Taylor & Francis
• Subjects: Biological and medical sciences; Cost Savings; Costs and Cost Analysis; Hernia, Ventral - economics; Hernia, Ventral - surgery; Humans; Medical sciences; Medicin och hälsovetenskap; Miscellaneous; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Procedures, Operative - economics; Sweden; Wounds and Injuries; Sweden; Europe; Hernia; Human; Incision; Abdominal disease; Health economy; Minimization; Technique; Repair; Public health; Cost efficiency analysis
• ISSN: 1102-4151; 1741-9271
• DOI: 10.1080/110241500750008312

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.