Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Saturday, August 01, 2015

Surgically Frugal

"All you needed to do is give the surgeons, the people on the ground, the information they needed to be helpful, and they jumped at the chance."
"Doctors would look at their bill and say 'Holy smokes, they charge $200 for that piece of foam? I don't need to use that'."
Dr. Michael Tymianski, head, Toronto University Health Network neurosurgery division

"I tend to adopt a policy ... that we use the best product that we believe works for the job and we say 'Bugger the cost'."
"There are others who are driven by cost and will say 'No, I don't care what your product is, I want to do it more cheaply."
Dr. Chris DeGara, president, Canadian Association of General Surgeons

"There are so few places in our lives where we are not aware of our costs. If you're shopping for groceries, if you're shopping for clothes, you're constantly aware of what things cost."
Dr. Leigh Sowerby, ear, nose and throat specialist, St. Joseph's Health Care, London, Ontario
J.P. Moczulski for National Post
J.P. Moczulski for National Post    Dr. Leigh Sowerby, a surgeon at St. Joseph's Hospital in London, Ont.: “There are so few places in our lives where we are not aware of our costs.”

Dr. Sowerby described a surgical instrument called a "triangle knife", which like all instruments laid out by nurses preparatory to surgery taking place in an operating room, is carefully unwrapped to ensure it is ready to be handed when and as needed by an operating-room nurse to the waiting surgeon's outstretched hand. The knife has a $110 price tag. It may or may not be used during a surgical procedure.

But it has been taken out of its sterile packing, ripped open for swift passage to a doctor who will want to use it, and is meant for use at every ENT (ear/nose/throat) operation. In the interests of prudence and cost-saving that customary unpacking of the triangle knife no longer occurs; it is left untouched but available. Since once unwrapped from its sterile packaging, if it isn't used, it is no longer sterile and must be discarded, a loss of $110 for an instrument that was not used.

J.P. Moczulski for National Post
J.P. Moczulski for National Post   Dr. Leigh Sowerby, of St. Joseph's Hospital in London, Ont., holds a disposable surgical instrument.

St. Joseph's hospital no longer indulges in that kind of waste. Once a surgeon indicates certainty that the product will be used during an operation it will be available but still kept wrapped. If it isn't in fact used, it will be returned to inventory for use during another operation. At Vancouver Coastal Health facilities an ENT surgeon replaced a tissue-sealing device that had a price tag of $375 with one that cost $35 and performed the same function.

A neurosurgeon specializing in minimally-invasive endoscopic surgery discovered a disposable scalpel used to make small incisions at the base of the brain cost $200. When he was informed how much the disposable scalpel cost he was astonished, and said: "Are you kidding? I can do that with a 65-cent scalpel blade". All examples of heightened awareness leading to operating cost-savings for hospitals.

Single use or disposable surgical supplies, including everything from sutures to scalpels and sterile draperies, total thousands per individual surgery, adding millions to hospital budget outlays. These costs are being compared to those of hospital salaries, coming in second place in a hospital's budget. Now, a new Canadian study points out that doctors in general have little knowledge of the cost of these items.

In response, many hospitals now familiarize surgeons with the sticker prices on their throwaway equipment. Moreover they've noted who among hospital surgical staff racks up high bills for disposables and take them to gentle task over it. As a result, doctors are becoming more aware, resulting in preferring products that cost less than a more costly alternative.
Varying costs, estimated by surgeons and administrators, of some of the disposable products used in surgery:
  • Bits for a microdebrider, used to break up nasal polyps: $100 to $200
  • Each staple from a surgical stapler: $100
  • Single-use stapler itself: $300
  • Triangle knife used for tight spaces: $100
  • Sutures (depending on use): 50 cents to $150
  • Implantable mesh for varying purposes: $50 to $6,000
  • Tissue-sealing device for ear, nose and throat operations: $35 to $375
  • Special scalpel used in neurosurgery: $200
  • Fibrin glue to stop internal bleeding: $360
At Toronto Western, the savings that came about through the new practices have made it possible for the neurosurgery division to bring more surgeons on staff and to substantially increase the number of operations the hospital can now offer. Best of all, the reduction of spending on single-use products has had no patient-outcome effect whatever.

Which hasn't stopped some surgeons from feeling uneasy about the situation, concerned that the move to use cheaper products during operations might place a small subset of patients at risk while achieving a negligible long-term gain. Dr. DeGara speaks of a surgical stapler that costs $300 for use in detaching an appendix, and the alternate is little loops costing $18, to be tightened around the appendix to produce a similar result.

The problem lies in the chance that the loop method might result in a one percent greater risk of complication, which would require some patients to spend longer hospital stays, thus effectively wiping out any cost savings realized.

John Lucas/Postmedia/File
John Lucas/Postmedia/File   “I tend to adopt a policy … that we use the best product that we believe works for the job and we say ‘Bugger the cost,’ ” says Dr. Chris De Gara, president of the Canadian Association of General Surgeons.

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