Cost-effectiveness of routine radiographs after emergent open cavity operations.
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.
Dossett
Lesly A
LA
Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA. lesly.dossett@vanderbilt.edu
Dittus
Robert S
RS
Speroff
Theodore
T
May
Addison K
AK
Cotton
Bryan A
BA
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