Yan James R, Oreskovich Stephan, Oduwole Kayode, Horner Nolan, Khanna Vickas, Adili Anthony
Orthopaedics, McMaster University, Hamilton, CAN.
Cureus. 2018 Nov 26;10(11):e3637. doi: 10.7759/cureus.3637.
Purpose Healthcare costs are increasingly garnering more media attention and there is increasing focus on improving efficiencies in daily practice. Orthopedic surgery is also subject to these fiscal pressures, particularly in arthroplasty surgeries, secondary to high volumes with costly equipment. Total knee arthroplasties (TKA) are one of the most common surgical procedures, with over 64,000 annual cases in Canada. Even marginal cost reductions per procedure can be compounded over the large volume to result in considerable savings. This study's purpose is to investigate and quantify the cost of wasted intraoperative cement used in primary TKA. Methods Residual amounts of wasted bone cement were collected and measured following uncomplicated primary TKAs performed by the senior authors in a high-volume arthroplasty centre between January and June 2017. Stryker Simplex® with Tobramycin Bone Cement was the specific institutional cement used. Results One hundred and two primary total knee arthroplasties were investigated. The results revealed that an average 91.2 g of surgical cement was wasted per case, with less than 30 g retained in the bone-implant interface (26.8 g). Institutional costs per package of cement is $120.62, amounting to $2.04 per gram of cement. This represents a value of $186.25 CAD per case. Conclusion On average, each primary TKA procedure wastes 91.2 g of bone cement per case. The value of this wasted cement is $186.25 CAD per TKA. When extrapolated to the most recent recorded numbers of TKAs done in Canada, that figure nears $12 million. The results of this study are important, as they reveal a potential source to target for both waste reduction and cost control.
目的 医疗保健成本越来越受到媒体的关注，并且人们越来越关注提高日常医疗实践的效率。骨科手术也面临这些财政压力，尤其是在关节置换手术中，由于手术量大且设备昂贵。全膝关节置换术（TKA）是最常见的外科手术之一，在加拿大每年有超过64,000例病例。即使每个手术的成本仅略有降低，在大量手术的情况下也能累积产生可观的节省。本研究的目的是调查和量化初次全膝关节置换术中浪费的术中骨水泥成本。方法 在2017年1月至6月期间，由资深作者在一个高容量关节置换中心进行的简单初次全膝关节置换术后，收集并测量浪费的骨水泥残留量。使用的特定机构骨水泥是含妥布霉素的史赛克Simplex®骨水泥。结果 对102例初次全膝关节置换术进行了调查。结果显示，每例手术平均浪费91.2克手术骨水泥，骨植入物界面保留的骨水泥少于30克（26.8克）。每包骨水泥的机构成本为120.62美元，即每克骨水泥2.04美元。这相当于每例手术186.25加元。结论 平均而言，每例初次全膝关节置换术每例浪费91.2克骨水泥。这些浪费的骨水泥价值为每例全膝关节置换术186.25加元。当推算到加拿大最近记录的全膝关节置换术数量时，这个数字接近1200万美元。这项研究的结果很重要，因为它们揭示了一个减少浪费和控制成本的潜在目标来源。
