Do the benefits of shorter hospital stay associated with the use of fleece-bound sealing outweigh the cost of the materials?
OBJECTIVE
To compare the cost of materials and hospitalization for standard techniques (suturing, stapling and electrocautery) for sealing the lung after pulmonary resection with those for a fleece-bound sealing procedure.


METHODS
This cost comparison analysis uses as its basis a prospective randomised clinical trial involving 152 patients with pulmonary lobectomy/segmentectomy (standard technique group: 77 patients; fleece-bound sealing group: 75 patients). The cost comparison was performed from the economic perspective of Austrian and German hospitals, taking into consideration the cost of materials for the two alternatives as well as the mean time to hospital discharge.


RESULTS
The clinical study found significantly smaller postoperative air leaks in the fleece-bound sealing group. The mean times to chest drain removal and to hospital discharge were also significantly reduced after application of fleece-bound sealing [5.1 vs. 6.3 days (P=0.022) and 6.2 vs. 7.7 days (P=0.01), respectively]. The cost of materials for sealing air leaks amounted to euro47 per patient in the standard technique group and euro410 per patient in the fleece-bound sealing group. The 1.5-day reduction in the length of hospital stay associated with fleece-bound sealing represents a saving of euro462 per patient.


CONCLUSIONS
There was an overall saving of euro99 for the fleece-bound sealing procedure compared to standard techniques for sealing the lung following pulmonary resection.
Division of Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria. udo@anegg.net
Udo
U
Anegg
Reinhard
R
Rychlik
Freyja
F
Smolle-Jüttner
D001317:Austria; D015505:Chest Tubes / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004322:Drainage / Q000191:economics / Q000295:instrumentation; D004338:Drug Combinations; D004564:Electrocoagulation / Q000191:economics*; D005340:Fibrinogen / Q000191:economics* / Q000627:therapeutic use; D005858:Germany; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D011013:Pneumonectomy / Q000009:adverse effects / Q000191:economics*; D011030:Pneumothorax / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D017792:Surgical Stapling / Q000191:economics*; D013536:Suture Techniques / Q000191:economics*; D013917:Thrombin / Q000191:economics* / Q000627:therapeutic use; D014014:Tissue Adhesives / Q000191:economics* / Q000627:therapeutic use
D004338:Drug Combinations; C518955:TachoSil; D014014:Tissue Adhesives; D005340:Fibrinogen; D013917:Thrombin