Bouthors C, Nguyen J, Durand L, Dubory A, Raspaud S, Court Ch
Orthopedic and Traumatology Surgery Department (Pr Ch Court), Bicetre University Hospital, AP-HP Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
Pharmacy and Sterilization Department, Bicetre University Hospital, AP-HP Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
Eur J Orthop Surg Traumatol. 2019 Dec;29(8):1631-1637. doi: 10.1007/s00590-019-02517-0. Epub 2019 Jul 26.
Healthcare facilities could minimize the cost of surgical instrument and implant processing by using single-use devices. The main objective was to prospectively compare the total cost of a single-use and reusable device used in short lumbar spine fusion.
A 1-year, single-centre, prospective study was performed on patients requiring a one- or two-level lumbar arthrodesis. Patients were randomized in two groups treated with either reusable or single-use device. A cost minimization analysis was performed using a micro-costing approach from a hospital perspective. Every step of the preparation process was timed and costed based on hourly wages of hospital employees, cleaning supplies and hospital waste costs.
Forty cases were evaluated. No significant difference in operation time was noted (reusable 176.1 ± 68.4 min; single use 190.4 ± 71.7 min; p = 0.569). Mean processing time for single-use devices was lower than for reusable devices (33 min vs. 176 min) representing a cost of 14€ versus 58€ (p < 0.05). Pre-/post-sterilization and spinal set recomposing steps were the most time-consuming in reusable device group. A total cost saving of 181€ per intervention resulted from the use and processing of the single-use device considering an additional sterilization cost of 137€ with the reusable device. The weight of the reusable device was 42 kg for three containers and 1.2 kg for the single-use device.
Owing to the absence of re-sterilization, single-use devices in one- and two-level lumbar fusion allow significant money and time savings. They may also avoid delaying surgery in case of reusable device unavailability.
医疗保健机构可通过使用一次性器械来降低手术器械和植入物处理成本。主要目的是前瞻性比较用于短节段腰椎融合术的一次性器械和可重复使用器械的总成本。
对需要进行单节段或双节段腰椎融合术的患者进行了为期1年的单中心前瞻性研究。患者被随机分为两组，分别使用可重复使用器械或一次性器械进行治疗。从医院角度采用微观成本核算方法进行成本最小化分析。根据医院员工的小时工资、清洁用品和医院废物成本，对准备过程的每一步进行计时和成本核算。
共评估了40例病例。手术时间无显著差异（可重复使用器械组为176.1±68.4分钟；一次性器械组为190.4±71.7分钟；p = 0.569）。一次性器械的平均处理时间低于可重复使用器械（33分钟对176分钟），成本分别为14欧元对58欧元（p < 0.05）。可重复使用器械组中，灭菌前/后和脊柱器械重新组装步骤耗时最长。考虑到可重复使用器械的额外灭菌成本为137欧元，使用和处理一次性器械每次干预可节省总成本181欧元。可重复使用器械三个容器的重量为42千克，一次性器械的重量为１.2千克。
由于无需再次灭菌，单节段和双节段腰椎融合术中使用一次性器械可显著节省资金和时间。在无法获得可重复使用器械的情况下，还可避免手术延迟。
