Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, M.C. H149, Hershey, PA, 17033, USA.
Surg Endosc. 2022 Sep;36(9):6949-6953. doi: 10.1007/s00464-022-09057-5. Epub 2022 Jan 31.
Despite the non-sterile nature of the alimentary tract, percutaneous endoscopic gastrostomy (PEG) procedures are often performed after creating a sterile surgical field to reduce infection risk. Our group has previously demonstrated no statistically significant difference in the rate of surgical site infection (SSI) following PEG performed with or without sterile operative fields. The purpose of this study is to evaluate the cost-effectiveness of working with or without sterile operative fields during PEG.
A decision tree model of PEG with and without sterile operative fields was created to evaluate the cost-effectiveness of these two methods. The primary outcome was incremental cost-effectiveness ratio with a ceiling willingness to pay threshold assumed of $100,000 per quality-adjusted life year (QALY). Costs were from the perspective of the healthcare system with a time horizon for the model of 90 days. Sensitivity analyses were performed on all model parameters.
In the base case analysis, sterile operative field PEG was cost-effective resulting in 0.2225 QALYs at an expected cost of $2,099. PEG procedures without a sterile operative field yielded less QALYs (0.2224) at a higher cost ($2,199) and were dominated. These procedures became cost-effective when the expected cost was < $1618 (e.g., $140 less than sterile operative field PEG) or when the SSI rate was < 1.6% (e.g., 0.2% higher than sterile operative field PEG) while holding all other variables constant.
PEG procedures performed without a sterile operative field can be cost-effective compared to procedures performed with a sterile operative field if the rates of SSI remain similar. Cost savings from foregoing a sterile operative field appear to be offset if the SSI rate increases > 0.2% above that of sterile operative field PEG procedures.
尽管消化道是非无菌的，但为了降低感染风险，经皮内镜下胃造口术（PEG）通常在创建无菌手术区域后进行。我们的团队之前已经证明，在有或没有无菌手术区域的情况下进行 PEG 手术，手术部位感染（SSI）的发生率没有统计学上的显著差异。本研究旨在评估在 PEG 手术中使用或不使用无菌手术区域的成本效益。
创建了一个有无菌手术区域的 PEG 决策树模型，以评估这两种方法的成本效益。主要结果是增量成本效益比，假设支付意愿上限为每质量调整生命年（QALY）$100,000。成本是从医疗保健系统的角度出发，模型的时间范围为 90 天。对所有模型参数进行了敏感性分析。
在基础案例分析中，无菌手术区域 PEG 具有成本效益，在预期成本为$2099 的情况下产生 0.2225 个 QALY。无无菌手术区域的 PEG 手术产生的 QALYs 较少（0.2224），成本较高（$2199），且处于劣势。当预期成本低于$1618（例如，无菌手术区域 PEG 少$140）或 SSI 率低于 1.6%（例如，无菌手术区域 PEG 高 0.2%）时，这些手术具有成本效益，同时保持所有其他变量不变。
如果 SSI 率保持相似，与使用无菌手术区域相比，无无菌手术区域的 PEG 手术可以具有成本效益。如果 SSI 率比无菌手术区域 PEG 手术高超过 0.2%，则放弃无菌手术区域的成本节约似乎会被抵消。
