title: Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: a cost-effectiveness analysis.
abstract: BACKGROUND
  Patients who undergo prolonged surgical procedures are at risk of developing pressure ulcers. Recent systematic reviews suggest that pressure redistribution overlays on operating tables significantly decrease the associated risk. Little is known about the cost effectiveness of using these overlays in a prevention program for surgical patients.
  
  
  METHODS
  Using a Markov cohort model, we evaluated the cost effectiveness of an intraoperative prevention strategy with operating table overlays made of dry, viscoelastic polymer from the perspective of a health care payer over a 1-year period. We simulated patients undergoing scheduled surgical procedures lasting ≥90 min in the supine or lithotomy position.
  
  
  RESULTS
  Compared with the current practice of using standard mattresses on operating tables, the intraoperative prevention strategy decreased the estimated intraoperative incidence of pressure ulcers by 0.51%, corresponding to a number-needed-to-treat of 196 patients. The average cost of using the operating table overlay was $1.66 per patient. Compared with current practice, this intraoperative prevention strategy would increase slightly the quality-adjusted life days of patients and by decreasing the incidence of pressure ulcers, this strategy would decrease both hospital and home care costs for treating fewer pressure ulcers originated intraoperatively. The cost savings was $46 per patient, which ranged from $13 to $116 by different surgical populations. Intraoperative prevention was 99% likely to be more cost effective than the current practice.
  
  
  CONCLUSIONS
  In patients who undergo scheduled surgical procedures lasting ≥90 min, this intraoperative prevention strategy could improve patients' health and save hospital costs. The clinical and economic evidence support the implementation of this prevention strategy in settings where it has yet to become current practice.
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ba'
authors.initials: B
authors.lastname: Pham
authors.forename: Laura
authors.initials: L
authors.lastname: Teague
authors.forename: James
authors.initials: J
authors.lastname: Mahoney
authors.forename: Laurie
authors.initials: L
authors.lastname: Goodman
authors.forename: Mike
authors.initials: M
authors.lastname: Paulden
authors.forename: Jeff
authors.initials: J
authors.lastname: Poss
authors.forename: Jianli
authors.initials: J
authors.lastname: Li
authors.forename: Nancy Joan
authors.initials: NJ
authors.lastname: Sikich
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Lourenco
authors.forename: Luciano
authors.initials: L
authors.lastname: Ieraci
authors.forename: Steven
authors.initials: S
authors.lastname: Carcone
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D006801:Humans; D007430:Intraoperative Care / Q000191:economics / Q000295:instrumentation*; D018803:Models, Economic; D058638:Operating Tables / Q000009:adverse effects / Q000191:economics; D011108:Polymers; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D003668:Pressure Ulcer / Q000191:economics / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic
chemical_list: D011108:Polymers