Elsevier

Surgery

Volume 150, Issue 1, July 2011, Pages 122-132
Surgery

Original Communication
Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: A cost-effectiveness analysis

Presented as a poster presentation at the 2009 Symposium, Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada, April 5–9, 2009 and as an oral presentation at the 31st Annual Meeting of the Society for Medical Decision Making, Los Angeles, CA, October 18–21, 2009
https://doi.org/10.1016/j.surg.2011.03.002Get rights and content

Background

Patients who undergo prolonged surgical procedures are at risk of developing pressure ulcers. Recent systematic reviews suggest that pressure redistribution overlays on operating tables significantly decrease the associated risk. Little is known about the cost effectiveness of using these overlays in a prevention program for surgical patients.

Methods

Using a Markov cohort model, we evaluated the cost effectiveness of an intraoperative prevention strategy with operating table overlays made of dry, viscoelastic polymer from the perspective of a health care payer over a 1-year period. We simulated patients undergoing scheduled surgical procedures lasting ≥90 min in the supine or lithotomy position.

Results

Compared with the current practice of using standard mattresses on operating tables, the intraoperative prevention strategy decreased the estimated intraoperative incidence of pressure ulcers by 0.51%, corresponding to a number-needed-to-treat of 196 patients. The average cost of using the operating table overlay was $1.66 per patient. Compared with current practice, this intraoperative prevention strategy would increase slightly the quality-adjusted life days of patients and by decreasing the incidence of pressure ulcers, this strategy would decrease both hospital and home care costs for treating fewer pressure ulcers originated intraoperatively. The cost savings was $46 per patient, which ranged from $13 to $116 by different surgical populations. Intraoperative prevention was 99% likely to be more cost effective than the current practice.

Conclusion

In patients who undergo scheduled surgical procedures lasting ≥90 min, this intraoperative prevention strategy could improve patients’ health and save hospital costs. The clinical and economic evidence support the implementation of this prevention strategy in settings where it has yet to become current practice.

Section snippets

Study design

We conducted a cost-effectiveness analysis using a Markov cohort simulation model. We followed guidelines for economic evaluation by the Canadian Agency for Drugs and Technologies in Health and recommendations by the Panel on Cost Effectiveness in Health and Medicine.19, 20 We simulated a cohort of patients with an average age of 63 years who underwent scheduled surgical procedures lasting ≥90 min in the supine or lithotomy position (Table I).21

The base case analysis was conducted from the

Clinical effectiveness

Table III displays results of the base case analysis. Over an average surgical duration of 4.6 h, the projected intraoperative incidence of pressure ulcers was 1.07% for patients with current practice and 0.57% for patients with the intraoperative prevention strategy, corresponding to an absolute decrease of 0.51%. On average, one needs to institute prevention for 196 surgical patients to prevent 1 pressure ulcer originated intraoperatively.

The projected incidence of stage 2–4 pressure ulcers

Discussion

According to recent systematic reviews, using the dry polymer overlays on operating tables significantly decreases the immediate postoperative incidence of pressure ulcers in patients who undergo surgical procedures lasting ≥90 min.4, 18, 21 We projected the health benefits and costs associated with the observed decrease in incidence of pressure ulcers over a 1-year period. According to our results, the intraoperative prevention strategy with the dry polymer overlays improves patient health and

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      The majority of the included studies (n = 8) evaluated the impact of mattress products for the prevention of pressure ulcers. The studies were conducted in a variety of settings: three studies (Gebhardt et al., 1996; Inman et al., 1993, 1999) were conducted in Intensive Care Units (ICUs); one in spinal injury centre (Catz et al., 2005); one in an orthopaedic unit (Price et al., 1999); one in the operating theatre (Pham et al., 2011b); one in long term care (Pham et al., 2011a); and, one included vascular, orthopaedic and medical elderly units (Iglesias et al., 2006). There were also differing definitions of pressure damage with some studies including grade 1 pressure damage (i.e. intact skin with non-blanching erythema) (Catz et al., 2005; Gebhardt et al., 1996; Price et al., 1999; Pham et al., 2011a,b), others grade 2 and above (Iglesias et al., 2006), and in the remaining studies it was unclear (Inman et al., 1993, 1999).

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