Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses
Notice bibliographique
Résumé
INTRODUCTION: Surgical outcomes associated with the use of microvascular anastomotic coupling devices (MACD) are well reported in the literature – compared with hand-sutured anastomoses, MACDs confer equivalent flap survival1,2 with reduced operative time.3,4 The purpose of this study was to assess the economics of a hand-sutured anastomosis compared with a coupler-assisted anastomosis. Following up on our previous study that focused on the economics in a Canadian context,5 we expanded the scope of our research to include the American market. MATERIALS AND METHODS: Economics were analyzed for a free flap requiring a single venous anastomosis carried out with either a hand-sutured anastomosis or with a coupler-assisted anastomosis using the GEM COUPLER (Synovis Micro Companies Alliance Incorporated; Birmingham, Alabama). All fixed and variable costs incurred with each respective anastomotic technique were identified with an activity-based cost analysis – relevant economic variables included disposable costs (e.g. coupler ring, suture), capital expenditure of the device, and both fixed and variable operating room (OR) costs (e.g. overhead, labor). Supplier and manufacturer price lists were used to quantify disposable costs and capital expenditures. Two separate literature reviews were carried out to identify microsurgical OR costs and operating time reductions observed with coupler-assisted anastomoses. Historically reported costs were converted to present day values using the United States Medical Care Inflation Rate. The total savings per use and the number of uses required to offset the coupler device’s capital expenditure were calculated. RESULTS: For each venous anastomosis use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis (cost of coupler ring less savings from unused suture). Total fixed and variable OR costs (includes overhead, labor, supplies, excludes physicians fees) were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device’s capital expenditure after 13 uses. CONCLUSION: Despite higher disposable costs, reduced operative time allows the anastomotic coupler to generate savings compared with hand-sutured anastomoses. Despite its limitations and simplicity, this study provides a practical economic analysis of the microvascular anastomotic coupler that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».