Cost-effectiveness of routine radiographs after emergent open cavity operations.
Cost-effectiveness of routine radiographs after emergent open cavity operations.
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紧急开腔手术后常规放射线检查的成本效益。
DOI：
10.1016/j.surg.2008.03.012
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发表时间：
2008
期刊：
影响因子：
3.8
通讯作者：
Cotton,BryanA
中科院分区：
文献类型：
--
作者：
Dossett,LeslyA;Dittus,RobertS;Speroff,Theodore;May,AddisonK;Cotton,BryanA
紧急手术会使手术海绵（RSS）残留的风险增加9倍。在大多数情况下，手术计数被错误地报告为正确。我们假设，机构的成本导致的RSS会使常规术中X线摄影（IOR）更符合成本效益比手术计数在预防RSS后，紧急开腔cases.METHODSA成本效益分析进行比较常规IOR与手术计数后，紧急开腔手术。从文献、标准化调查的专家意见和现有的机构数据中获得参数估计值。在基础病例的假设下，REPTSRoutine IOR是首选策略（每例患者705 vs 1155）。手术计数策略主要由RSS后发生的机构成本决定。只要手术计数的敏感性低于98%，且法律的费用高于44，000/例RSS，则优先采用常规IOR。结论SRoutineIOR是减少这种可预防的医疗错误发生的简单、成本有效的选择。与RSS相关的机构费用和法律费用主导了手术计数策略的成本，使常规IOR比手术计数更有效。
BACKGROUNDEmergency 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.METHODSA 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.RESULTSRoutine IOR was the preferred strategy (705vs 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 44,000percaseofRSS.CONCLUSIONSRoutineIORisasimple,cost-effectiveoptiontoreducetheoccurrenceofthispreventablemedicalerror.InstitutionalcostsandlegalfeesassociatedwithRSSdominatethecostofthesurgicalcountstrategy,makingroutineIORamorecost-effectivestrategythansurgicalcountsgiventhebestavailableparameterestimates.
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