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. 2018 Mar;32(3):1586-1592.
doi: 10.1007/s00464-017-6001-3. Epub 2017 Dec 22.

Using outcomes data to justify instituting new technology: a single institution's experience

P M Starker  1   2 , B Chinn  3
Affiliations

Using outcomes data to justify instituting new technology: a single institution's experience

P M Starker et al. Surg Endosc. 2018 Mar.

Abstract

Background: The PILLAR II trial demonstrated PINPOINT is safe, feasible to use with no reported adverse events and resulted in no anastomotic leaks in patients who had a change in surgical plan based on PINPOINT's intraoperative assessment of tissue perfusion during colorectal resection. Whether the cost savings associated with this reduction in anastomotic complications can offset the cost of investing in PINPOINT is unknown.

Methods: We performed a retrospective analysis of all patients (N = 347) undergoing colectomy with primary anastomosis from January 2015 to April 2016. These patients were stratified based on whether fluorescence imaging was used intraoperatively. The clinical outcomes of these patients were then evaluated based on their development of an anastomotic leak or stricture. The direct hospital costs per case were then calculated, and the economic impact of using fluorescence imaging was examined to assess whether decreased direct costs would justify the initial expenditures to purchase new technology (PINPOINT System, NOVADAQ, Canada).

Results: Fluorescence imaging in colorectal surgery using PINPOINT reduced the anastomotic failure rate in patients who underwent colon resection. The PINPOINT group (n = 238) had two (0.84%) anastomotic failures, while the non-PINPOINT group (n = 109) had six (5.5%) anastomotic failures. In the PINPOINT group, 11 (4.6%) patients had a change in the resection margin based on the results of the fluorescence imaging, and none of these patients experienced an anastomotic failure. Cost per case was less in the PINPOINT group secondary to fewer direct costs associated with complications.

Conclusions: These results validate the findings of the PILLAR II trial and confirm the decrease in direct costs due to reduction in anastomotic failures as a result of using PINPOINT justified the expense of the new technology after just 143 cases.

Keywords: Anastomotic leak; Colorectal surgery; Hospital value proposition; Intraoperative fluorescence imaging; NSQIP; PINPOINT.

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Conflict of interest statement

Drs. Paul M. Starker and Bertram Chinn are participants of NOVADAQ’s Speaker’s Bureau.

Figures

Fig. 1
Fig. 1
Projected cost savings associated with the use of PINPOINT at OMC
See this image and copyright information in PMC

References

    1. Zenn MR. Fluorescent angiography. Clin Plast Surg. 2011;38(2):293–300. doi: 10.1016/j.cps.2011.03.009. - DOI - PubMed
    1. Harless CA. Tailoring through technology: a retrospective review of a single surgeon’s experience with implant-based breast reconstruction before and after implementation of laser-assisted indocyanine green angiography. Breast J. 2016;22(3):274–281. doi: 10.1111/tbj.12576. - DOI - PubMed
    1. Harless CA. Current strategies with 2-staged prosthetic breast reconstruction. Gland Surg. 2015;4(3):204–211. - PMC - PubMed
    1. Duggal CS. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction. Aesthet Surg J. 2014;34(1):61–65. doi: 10.1177/1090820X13514995. - DOI - PubMed
    1. Sood M. Potential of the SPY intraoperative perfusion assessment system to reduce ischemic complications in immediate postmastectomy breast reconstruction. Ann Surg Innov Res. 2013;7(1):9. doi: 10.1186/1750-1164-7-9. - DOI - PMC - PubMed

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