title: Cost-effectiveness of routine radiographs after emergent open cavity operations.
abstract: BACKGROUND
  Emergency surgery increases the risk of a retained surgical sponge (RSS) by 9-fold. In most cases, surgical counts are falsely reported as correct. We hypothesized that the institutional costs resulting from a RSS would make routine intraoperative radiography (IOR) more cost-effective than surgical counts in preventing RSS after emergent open cavity cases.
  
  
  METHODS
  A cost-effectiveness analysis was performed to compare routine IOR with surgical counts after emergent open cavity operations. Parameter estimates were obtained from the literature, expert opinion via a standardized survey, and existing institutional data.
  
  
  RESULTS
  Routine IOR was the preferred strategy ($705 vs $1155 per patient) under the assumptions of the base case. The surgical count strategy was dominated by the institutional costs incurred after a RSS. Routine IOR was preferential as long as the sensitivity of surgical counts was less than 98% and the legal fees were more than $44,000 per case of RSS.
  
  
  CONCLUSIONS
  Routine IOR is a simple, cost-effective option to reduce the occurrence of this preventable medical error. Institutional costs and legal fees associated with RSS dominate the cost of the surgical count strategy, making routine IOR a more cost-effective strategy than surgical counts given the best available parameter estimates.
authors.affiliation: Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA. lesly.dossett@vanderbilt.edu
authors.forename: Lesly A
authors.initials: LA
authors.lastname: Dossett
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.forename: Addison K
authors.initials: AK
authors.lastname: May
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
mesh_terms: D000005:Abdomen / Q000601:surgery; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004630:Emergencies; D005547:Foreign Bodies / Q000000981:diagnostic imaging* / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007432:Intraoperative Period; D019300:Medical Errors / Q000191:economics / Q000517:prevention & control*; D011859:Radiography / Q000191:economics*; D012680:Sensitivity and Specificity; D015503:Surgical Sponges; D019616:Thoracic Surgical Procedures