Prevention of retained surgical sponges: A decision-analytic model predicting relative cost-effectiveness

Scott E. Regenbogen, Caprice C. Greenberg, Stephen C. Resch, Anantha Kollengode, Robert R. Cima, Michael J. Zinner, Atul A. Gawande

Research output: Contribution to journalArticle

Abstract

Background: New technologies are available to reduce or prevent retained surgical sponges (RSS), but their relative cost effectiveness are unknown. We developed an empirically calibrated decision-analytic model comparing standard counting against alternative strategies: universal or selective x-ray, bar-coded sponges (BCS), and radiofrequency-tagged (RF) sponges. Methods: Key model parameters were obtained from field observations during a randomized-controlled BCS trial (n = 298), an observational study of RSS (n = 191,168), and clinical experience with BCS (n ∼ 60,000). Because no comparable data exist for RF, we modeled its performance under 2 alternative assumptions. Only incremental sponge-tracking costs, excluding those common to all strategies, were considered. Main outcomes were RSS incidence and cost-effectiveness ratios for each strategy, from the institutional decision maker's perspective. Results: Standard counting detects 82% of RSS. Bar coding prevents ≥97.5% for an additional $95,000 per RSS averted. If RF were as effective as bar coding, it would cost $720,000 per additional RSS averted (versus standard counting). Universal and selective x-rays for high-risk operations are more costly, but less effective than BCS-$1.1 to 1.4 million per RSS event prevented. In sensitivity analyses, results were robust over the plausible range of effectiveness assumptions, but sensitive to cost. Conclusion: Using currently available data, this analysis provides a useful model for comparing the relative cost effectiveness of existing sponge-tracking strategies. Selecting the best method for an institution depends on its priorities: ease of use, cost reduction, or ensuring RSS are truly "never events." Given medical and liability costs of >$200,000 per incident, novel technologies can substantially reduce the incidence of RSS at an acceptable cost.

Original languageEnglish (US)
Pages (from-to)527-535
Number of pages9
JournalSurgery
Volume145
Issue number5
DOIs
StatePublished - May 2009
Externally publishedYes

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Foreign Bodies
Cost-Benefit Analysis
Porifera
Costs and Cost Analysis
X-Rays
Technology
Medical Errors
Legal Liability
Incidence
Observational Studies

ASJC Scopus subject areas

  • Surgery

Cite this

Regenbogen, S. E., Greenberg, C. C., Resch, S. C., Kollengode, A., Cima, R. R., Zinner, M. J., & Gawande, A. A. (2009). Prevention of retained surgical sponges: A decision-analytic model predicting relative cost-effectiveness. Surgery, 145(5), 527-535. https://doi.org/10.1016/j.surg.2009.01.011

Prevention of retained surgical sponges : A decision-analytic model predicting relative cost-effectiveness. / Regenbogen, Scott E.; Greenberg, Caprice C.; Resch, Stephen C.; Kollengode, Anantha; Cima, Robert R.; Zinner, Michael J.; Gawande, Atul A.

In: Surgery, Vol. 145, No. 5, 05.2009, p. 527-535.

Research output: Contribution to journalArticle

Regenbogen, SE, Greenberg, CC, Resch, SC, Kollengode, A, Cima, RR, Zinner, MJ & Gawande, AA 2009, 'Prevention of retained surgical sponges: A decision-analytic model predicting relative cost-effectiveness', Surgery, vol. 145, no. 5, pp. 527-535. https://doi.org/10.1016/j.surg.2009.01.011
Regenbogen SE, Greenberg CC, Resch SC, Kollengode A, Cima RR, Zinner MJ et al. Prevention of retained surgical sponges: A decision-analytic model predicting relative cost-effectiveness. Surgery. 2009 May;145(5):527-535. https://doi.org/10.1016/j.surg.2009.01.011
Regenbogen, Scott E. ; Greenberg, Caprice C. ; Resch, Stephen C. ; Kollengode, Anantha ; Cima, Robert R. ; Zinner, Michael J. ; Gawande, Atul A. / Prevention of retained surgical sponges : A decision-analytic model predicting relative cost-effectiveness. In: Surgery. 2009 ; Vol. 145, No. 5. pp. 527-535.
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