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Cost minimisation analysis of change in closure technique of midline incisions.

OBJECTIVES
To make a cost minimisation analysis of incisional hernia repair at a county hospital and extrapolate the results nationally.


SETTING
County hospital, Sweden.


SUBJECTS
861 patients who underwent midline laparotomy between August 1989 and November 1992.


INTERVENTIONS
In April 1991 surgeons were urged to change their suture technique towards wound closure with a suture length: wound length ratio of at least 4.


MAIN OUTCOME MEASURES
Rate of incisional hernia at 12 months and the number of hernia repairs required with associated costs.


RESULTS
The average cost of one hernia repair was SEK 42643. After the intervention the risk of requiring a hernia repair was reduced by 0.016 for each patient operated on through a midline incision. The cost was reduced by SEK 686 and the cost of an operation 5 minutes longer was SEK 570, so the intervention generated savings of SEK 116 for each patient operated on. A similar reduction on a national level would yield annual savings of SEK 2107140, which may be regarded as the annual opportunity cost of an inadequate surgical technique in Sweden.


CONCLUSIONS
An alteration to the suture technique that reduces the rate of incisional hernia and the number of hernia repairs required is cost effective and generates savings.