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At least 73 records · Page 4Linked to original sources
PubMed2002

A study of added costs of laparoscopic cholecystectomy based on surgery preference cards.

Hospitals are pressured to cut expenses to generate a profit, but many current surgical procedures still fall below a "break-even" point. Laparoscopic cholecystectomy is a high-volume surgical procedure that can be profitable for hospitals if costs are reduced and complications minimized. Our limited liability corporation of independent surgical specialists examined the preference cards of ten surgeons who performed laparoscopic cholecystectomies in August 2000. We wished to determine whether these surgeons differed in their use of disposable equipment and devices for the same surgical procedure. All of the disposable equipment and devices studied were assigned a price by the hospital purchasing department that was representative of the hospital costs and not what was billed to the patient. The sum total of disposable instruments for a single operative case in which laparoscopic cholecystectomy was performed ranged from $92 to $637 (mean $333) depending on the preference of the surgeon. Our study points out the differences in expenses between surgeons. Maintaining this type of expense tracking can apply to other procedures and is a good place to start a surgeon-led and hospital-based cost-saving initiative.

Cholecystectomy, Laparoscopic↗
PubMed1975

[Radiation sterilization of disposable medical equipment].

In the Institute of Nuclear Research in Warsaw, the double-function linear electron accelerator LAE 13/9 has been operating since 1972, currently yielding radiation in the amount equivalent to 1 millon Ci of cobalt 60, thus providing unique research possibilities. The author has discussed the technical base in Poland and Comecon Member Countries, and planning and prognostic in this respect in other countries, as well.

Disposable Equipment↗
PubMedDate not supplied

Prospective evaluation of costs of disposable accessories in diagnostic and therapeutic ERCP.

Procedural (room fee) reimbursement from insurance payers is usually fixed for individual endoscopic procedures and may not include the costs of disposable equipment. This study estimated costs of disposable items used in ERCP procedures and calculated the percentage of total reimbursement spent on such equipment. A total of 248 ERCPs were performed in a 5-month study period, 192 (77%) of which were therapeutic. Total reimbursement was estimated to be $112,262 ($452 per procedure) and total disposable equipment costs were $47,195 ($190 per procedure), or 42% of total reimbursement. Disposable instrument costs in diagnostic ERCP approximated 13% of those associated with therapeutic ERCP, and the latter costs in turn utilized more than 60% of Medicare/Medicaid room fee reimbursement. This reimbursement may be inadequate to cover both disposable instrument costs and other procedural expenses, such as admit-recovery costs, nursing assistance, expenses related to endoscope purchase and capitalization, and equipment cleaning or sterilization. Our data suggest the need for either re-usable endoscopic accessories or adequate compensation to cover disposable instrument costs.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2005

Noninvasive vs. selective invasive biliary imaging for acute biliary pancreatitis: an economic evaluation by using decision tree analysis.

BACKGROUND: ERCP is used selectively in patients with acute biliary pancreatitis (ABP). In patients with ABP, ERCP often is difficult and has the potential to cause further damage. In addition, the prevalence of residual choledocholithiasis in ABP is low (<30%). EUS and MRCP accurately diagnose choledocholithiasis, but the performance of MRCP may be inferior in ABP. EUS, with ERCP when a stone is seen, has been shown to be feasible. This study assessed the relative costs and outcomes of EUS and MRCP in patients with ABP compared with standard care involving selective ERCP. METHODS: A decision tree was constructed, modeling standard care for nonsevere ABP (selective ERCP) and severe ABP (ERCP with sphincterotomy and balloon sweep). The other arms included either EUS or MRCP first, with the conversion to or the addition of ERCP when a bile-duct stone was seen. Probabilities and accuracy of EUS and MRCP were taken from published data. Costs were locally quantified in Canadian dollars (CDN), including nursing/technical/professional personnel, equipment maintenance, and disposable equipment. The robustness of assumptions was tested by sensitivity analyses. RESULTS: Overall, EUS in all patients with ABP was marginally dominant compared with standard care with selective ERCP ($58 CDN per patient less expensive; 0.9% fewer cases of pancreatitis [ERCP-related or recurrent]). In the severe ABP subgroup, EUS was more clearly dominant ($742 CDN per patient less expensive; 3% fewer cases of pancreatitis), and the nonsevere subgroup had an incremental cost-effectiveness ratio of $17,000 per case of pancreatitis avoided. MRCP was more expensive than EUS in both subgroups. CONCLUSIONS: EUS is dominant in severe ABP. In nonsevere ABP, it is slightly more costly but is associated with fewer ERCPs and ERCP-related complications. A randomized trial would help to quantify the benefits of avoiding ERCP in these patients.

Acute Disease↗
PubMed2007

Laparoscopic appendectomy in children: use of the endoloop vs the endostapler.

HYPOTHESIS: Two techniques are used for laparoscopic appendectomy (LA): division of the mesoappendix with the harmonic scalpel and ligation of the appendix with an endoloop (EL), or division of the mesoappendix and appendix with an endostapler (ES). Using an ES is a cost-effective technique that provides an outcome benefit in children who require appendectomy. DESIGN: Case series. SETTING: Academic, tertiary care children's hospital. PATIENTS: Seventy-five children who underwent LA from January 1, 2002, to March 31, 2004. INTERVENTION: Laparoscopic appendectomy. MAIN OUTCOME MEASURES: Age, diagnosis, length of stay, surgical time, total operating room time, complications, and instrumentation costs were compared between the EL and ES groups. RESULTS: There was no significant difference in age, length of stay, perforated, gangrenous, or acute appendicitis diagnoses, or complications between the groups. The surgical time and total operating room time for LA in children in the ES group were significantly shorter than in children in the EL group by 15% and 17%, respectively (P<.05). The disposable equipment costs for LA were $201 per case in the ES group vs $400 per case in the EL group. The mean 14.9-minute increase in total operating room time in children in the EL group resulted in $373 of additional operating room and anesthesia costs. The decreased disposable equipment costs and shorter surgical time of LA in the ES group led to cost savings of $572 per case as compared with children who underwent LA with an EL. CONCLUSIONS: There is no significant difference in outcome between children who undergo LA with an EL or with an ES. However, this study supports the use of the ES for LA as a more cost-effective technique that is associated with reduced surgical time.

Adolescent↗
PubMed2002

Explosive ordinance disposal team equipment and its use in diagnosing extremity trauma.

A 31-year-old man presented to the Rakkasan battalion aid station, located at the Qandahar Airport, Afghanistan, with complaints and physical findings consistent with those that would either support a grade III ankle sprain or fracture. The battalion aid station is an echelon I level of care. This facility does not have radiographic capabilities. With the closest radiology facility located in Seeb, Oman the 710th Explosive Ordinance Disposal team, which was operating in the area, was contacted. This unit was able to perform radiographs in a timely manner to help aid in correctly diagnosing the injury.

Adult↗
PubMed2002

Intensive care units in Croatia: 2001 survey.

AIM: To establish a framework for the Intensive Care Units (ICU) Register in Croatia, and examine the relation between their present organization and medical practices and their outcome performances. METHODS: The survey of a total of 123 ICUs in Croatia was conducted between February 1 and October 31, 2001. Census questionnaires were filled out by ICU chiefs of staff. Demographic data, data on hospital and ICU structure and organization, disposable equipment, admission and discharge decision-making, outcome, and patient demographic data were collected for February 1, 2001. Descriptive statistics was used for data analysis. RESULTS: On February 1, 2001, there were 123 ICUs in Croatia. The questionnaire was filled out by 117 ICU chiefs of staff (95% response rate). The total number of ICUs beds was 900, comprising 3.3% of all hospital beds. Croatian ICUs were divided into 13 subtypes; 89% of them were adjoined to hospital departments of various subspecialties and only 13 (11%) were freestanding. The number of ICUs per hospital, number of ICU beds, quantity of disposable equipment, and number of permanently employed medical and nursing staff within hospitals and individual units increased as hospitals enlarged. Also, the number of mixed surgical/medical and coronary care/medical units decreased, and specialized units became prevalent. The mortality data in Croatian ICUs were similar to those reported elsewhere in the world: the lowest mortality was found in psychiatric ICUs (3%) and the highest in an ICU for infective diseases (30%), followed by neurological (19%), medical (17%), and respiratory (16%) ICUs. CONCLUSION: Establishing a database on intensive care medicine and assessing the performance of ICUs in Croatia could serve as a model for improvement of ICU service in other transition countries.

Croatia↗
PubMed2003

[Recycling and reuse of disposable products in radiology].

Legitimacy and appropriateness of recycling and reuse of single-use disposable medical devices is a common issue in many areas of medicine. Advocates of reprocessing claim economic savings and environmental benefits. From the manufacturers' point of view, the single use is a characteristic property of their products. Moreover, they warn that using of recycled instruments makes the procedure more difficult and increases the rate of adverse events. As comparative tests demonstrate, reused products are sometimes inferior to the genuine ones with respect to mechanical properties, but these differences may have relatively little consequence for the performance of the products and the success rate of the interventions. With rigorous cleaning and sterilizing of the instruments, patients do not run an increased risk of infection. Sterile single-use products are subject to the German Medical Products Act (1994) and the German Medical Devices Ordinance (1998). New legal provisions (in force since January 1st 2002) have restricted professional recycling of used devices further. Companies reprocessing medical products for the original users are free from certification liability. CE can no longer be issued for devices newly placed on the market. Lawyers controversially discuss whether patients must be informed about the use of recycled products. In view of the otherwise strict regulations concerning the information given to patients, it seems imperative to obtain a written informed consent when reprocessed devices are used. This might interfere with the confidential relationship of patients and physicians. The combination of increased risk, strict legal regulations, ethical concern and adverse publicity demand to refrain from reprocessing and reusing disposable equipment in diagnostic and interventional radiology.

Disposable Equipment↗
PubMed2001

The prevalence of visible and/or occult blood on anesthesia and monitoring equipment.

The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) have attempted to stop the spread of blood-borne pathogens by issuing several recommendations and regulations. However, unless healthcare workers comply with these standards, they are not effective. In the anesthesia care environment, the anesthetist is responsible for ensuring that the equipment is clean, and disinfected, before use. We studied the prevalence of visible and occult blood on 6 types of anesthesia and monitoring equipment identified as ready for use in 28 operating suites, in 2 facilities. The sample consisted of 336 observations of the 6 types of equipment. The equipment was inspected for visible blood and then tested for occult blood using a 3-stage phenolphthalein test. Of the 336 observations, 110 (32.7%), were positive for occult blood with only 6 showing visible blood. The presence of blood on this equipment may be in direct violation of the OSHA Blood-borne Pathogen Standard and the infection control guidelines of the American Association of Nurse Anesthetists. Furthermore, the presence of blood on this equipment may increase the risk for nosocomial and occupational exposure to viral and bacterial pathogens. Recommendations were made to decrease the risks from this contamination by redesigning equipment, increasing the use of disposable equipment, and ensuring compliance with effective infection control practices.

Anesthesia↗
PubMedDate not supplied

Patients with prion disease: planning for eye surgery.

Human prion diseases are characterized by rapidly progressive fatal neurodegenerative symptoms. In prion diseases, neural tissues have the greatest potential for infectivity, and ocular tissues are included in the category of high infection risk. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have published specific infection control guidelines for prion diseases. Standard Precautions are utilized for all patient care. Additional and more stringent measures are indicated when patients with known or suspected prion disease require ocular surgery. Measures include: notification of infection control, operating room, and decontamination personnel; use of disposable instruments whenever possible; special processing for non-disposable instruments; identification of tissue and laboratory specimens; and incineration or other appropriate treatment of infectious waste. Clumsiness, vision changes, and myoclonus in association with prion disease may predispose patients to traumatic ocular emergencies. Proactively, procedure areas should utilize a multidisciplinary approach to do the following: identify urgent surgical procedures that are likely to be required by these patients; evaluate cleaning procedures that will result in effective tissue removal; identify critical, non-disposable equipment for which there are no disposable alternatives; identify decontamination methods available to the specific facility as well as to identify which recommended decontamination procedures may not be appropriate for ocular instrumentation; and develop precautionary procedures specifically for decontamination of equipment and instruments.

Equipment Contamination↗
PubMed1982

A new, simple method for intraoperative reinfusion.

The disposable device for intraoperative reinfusion consists of a polycarbonate container with an antifoam-coated filter. One port is connected to the suction tip; the other port is attached to wall suction. Sodium citrate solution (50 to 100 ml) is aspirated first, followed by 400 ml of shed blood. The full container is passed to the anesthetist who turns the device upside down and starts reinfusion from the bottom, previously the top port of the container. In experiments with dogs, this procedure resulted in only slight hemolysis, a minor drop in platelet count, and no mortality or morbidity. This new method of reinfusion combines the advantages of simplicity, disposable equipment, and low blood trauma.

Animals↗
PubMed2002

Bare bones laparoscopy: a randomized prospective trial of cost savings in laparoscopic cholecystectomy.

OBJECTIVE: Rising costs and lowered reimbursements make value essential if laparoscopic cholecystectomy (LC) is to be offered to patients without condemning providers to financial loss. We hypothesize that our protocol increases this value. Once practiced, operative time, complications, and patient satisfaction compare with those of the typical method. METHODS: We prospectively randomized 50 consecutive patients equally to control or experimental LC according to our protocol. Equipment costs, operative time, conversions, complications, pain, and return to work were compared. The student's t test was used for comparisons. RESULTS: Mean disposable equipment costs were 173.00 dollars +/- 43.45 dollars and 434.42 dollars +/- 50.54 dollars for the study and control groups, respectively (P < .0001). Mean operative times were 67.26 +/- 15 and 70.60 +/- 19 minutes, respectively. CONCLUSIONS: The "bare bones" protocol is safe. It has a short learning curve, demonstrates a cost advantage over the common method, and requires no additional operative time. Pain, time to return to work, and satisfaction are equivalent.

Adult↗