RESUMO
BACKGROUND. The energy demand of interventional imaging systems has historically been estimated using manufacturer-provided specifications rather than directly measured. OBJECTIVE. The purpose of this study was to investigate the energy consumption of interventional imaging systems and estimate potential savings in the carbon emissions and electricity costs of such systems through hypothetical operational adjustments. METHODS. An interventional radiology suite, neurointerventional suite, radiology fluoroscopy unit, two cardiology laboratories, and two urology fluoroscopy units were equipped with power sensors. Power measurement logs were extracted for a single 4-week period for each radiology and cardiology system (all between June 1, 2022, and November 28, 2022) and for the 2-week period from July 31, 2023, to August 13, 2023, for each urology system. Power statuses, procedure time stamps, and fluoroscopy times were extracted from various sources. System activity was divided into off, idle (no patient in room), active (patient in room for procedure), and net-imaging (active fluoroscopic image acquisition) states. Projected annual energy consumption was calculated. Potential annual savings in carbon emissions and electricity costs through hypothetical operational adjustments were estimated using published values for Switzerland. RESULTS. Across the seven systems, the mean power draw was 0.3-1.1, 0.7-7.4, 0.9-7.6, and 1.9-12.5 kW in the off, idle, active, and net-imaging states, respectively. Across systems, the off state, in comparison with the idle state, showed a decrease in the mean power draw of 0.2-6.9 kW (relative decrease, 22.2-93.2%). The systems had a combined projected annual energy consumption of 115,684 kWh (range, 3646-26,576 kWh per system). The systems' combined projected energy consumption occurring outside the net-imaging state accounted for 93.3% (107,978/115,684 kWh) of projected total energy consumption (range, 89.2-99.4% per system). A hypothetical operational adjustment whereby all systems would be switched from the idle state to the off state overnight and on weekends (versus being operated in idle mode 24 hours a day, 7 days a week) would yield the following potential annual savings: for energy consumption, 144,640 kWh; for carbon emissions, 18.6 metric tons of CO2 equivalent; and for electricity costs, US$37,896. CONCLUSION. Interventional imaging systems are energy intensive, having high consumption outside of image acquisition periods. CLINICAL IMPACT. Strategic operational adjustments (e.g., powering down idle systems) can substantially decrease the carbon emissions and electricity costs of interventional imaging systems.
Assuntos
Radiografia Intervencionista , Humanos , Radiografia Intervencionista/economia , Fluoroscopia/economia , Urologia/economia , Cardiologia/economia , Eletricidade , Pegada de CarbonoRESUMO
RATIONALE AND OBJECTIVES: To determine the most cost-effective strategy for pelvic bone marrow biopsies. MATERIALS AND METHODS: A decision analytic model from the health care system perspective for patients with high clinical concern for multiple myeloma (MM) was used to evaluate the incremental cost-effectiveness of three bone marrow core biopsy techniques: computed tomography (CT) guided, and fluoroscopy guided, no-imaging (landmark-based). Model input data on utilities, costs, and probabilities were obtained from comprehensive literature review and expert opinion. Costs were estimated in 2023 U.S. dollars. Primary effectiveness outcome was quality adjusted life years (QALY). Willingness to pay threshold was $100,000 per QALY gained. RESULTS: No-imaging based biopsy was the most cost-effective strategy as it had the highest net monetary benefit ($4218) and lowest overall cost ($92.17). Fluoroscopy guided was excluded secondary to extended dominance. CT guided biopsies were less preferred as it had an incremental cost-effectiveness ratio ($334,043) greater than the willingness to pay threshold. Probabilistic sensitivity analysis found non-imaging based biopsy to be the most cost-effective in 100% of simulations and at all willingness to pay thresholds up to $200,000. CONCLUSION: No-imaging based biopsy appears to be the most cost-effective strategy for bone marrow core biopsy in patients suspected of MM. CLINICAL RELEVANCE: No imaging guidance is the preferred strategy, although image-guidance may be required for challenging anatomy. CT image interpretation may be helpful for planning biopsies. Establishing a non-imaging guided biopsy service with greater patient anxiety and pain support may be warranted.
Assuntos
Medula Óssea , Análise Custo-Benefício , Biópsia Guiada por Imagem , Mieloma Múltiplo , Tomografia Computadorizada por Raios X , Humanos , Fluoroscopia/economia , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/métodos , Biópsia Guiada por Imagem/economia , Biópsia Guiada por Imagem/métodos , Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/economia , Anos de Vida Ajustados por Qualidade de Vida , Técnicas de Apoio para a Decisão , Radiografia Intervencionista/economia , Radiografia Intervencionista/métodosRESUMO
BACKGROUND: Spine surgery costs are notoriously high, and there are already criticisms and concerns over the economic effects. There is no consensus on cost variation with robot-assisted spine fusion (rLF) compared with a manual fluoroscopic freehand (fLF) approach. This study looks to compare the early costs between the robotic method and the freehand method in lumbar spine fusion. METHODS: rLFs by one spine surgeon were age, sex, and approach-matched to fLF procedures by another spine surgeon. Variable direct costs, readmissions, and revision surgeries within 90 days were reviewed and compared. RESULTS: Thirty-nine rLFs were matched to 39 fLF procedures. No significant differences were observed in clinical outcomes. rLF had higher total encounter costs (P < 0.001) and day-of-surgery costs (P = 0.005). Increased costs were mostly because of increased supply cost (0.0183) and operating room time cost (P < 0.001). Linear regression showed a positive relationship with operating room time and cost in rLF (P < 0.001). CONCLUSION: rLF is associated with a higher index surgery cost. The main factor driving increased cost is supply costs, with other variables too small in difference to make a notable financial effect. rLF will become more common, and other institutions may need to take a closer financial look at this more novel instrumentation before adoption.
Assuntos
Fluoroscopia , Vértebras Lombares , Procedimentos Cirúrgicos Robóticos , Humanos , Vértebras Lombares/cirurgia , Parafusos Pediculares , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Custos e Análise de Custo , Fluoroscopia/economia , Fluoroscopia/métodos , Masculino , Feminino , Estudos de CoortesRESUMO
The aim of this study is to evaluate the cost-effectiveness of an extended use of 3D non-fluoroscopic mapping systems (NMSs) during paediatric catheter ablation (CA) in an adult EP Lab. This study includes 58 consecutive patients (aged between 8 and 18) who underwent CA from March 2005 to February 2015. We compare the fluoroscopy data of two groups: group I, patients who underwent CA from 2005 to 2008 using only fluoroscopy, and group II, patients who underwent CA from 2008 to 2015 performed also using NMSs. Two cost-effectiveness analyses were carried out: the first method was based on the alpha value (AV), and the second one was based on the value of a statistical life (VSL). For both methods, a children's correction factor was also considered. The reduction cost estimated from all these methods was compared to the real additional cost of using NMSs. The use of an NMS during a CA procedure has led to an effective dose reduction (ΔE) of 2.8 milli-Sievert. All presented methods are based on parameters with a wide range of values. The use of an NMS, applying directly AV values or VSL values, is not cost-effective for most countries. Only considering the children's correction factor, the CA procedure using an NMS seems to be cost-effective. The cost-effectiveness of a systematic use of NMSs during CA procedures in children and teenagers remains a challenging task. A positive result depends on which value of AV or VSL is considered and if the children's correction factor is applied or not.
Assuntos
Ablação por Cateter/métodos , Fluoroscopia/economia , Imageamento Tridimensional/economia , Adolescente , Mapeamento Potencial de Superfície Corporal/economia , Ablação por Cateter/economia , Criança , Análise Custo-Benefício , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Exposição à Radiação/prevenção & controleRESUMO
OBJECTIVE: The purpose of this study was to determine the cost-effectiveness of landmark-based and image-guided intraarticular steroid injections for the initial treatment of a population with adhesive capsulitis. MATERIALS AND METHODS: A decision analytic model from the health care system perspective over a 6-month time frame for 50-year-old patients with clinical findings consistent with adhesive capsulitis was used to evaluate the incremental cost-effectiveness of three techniques for administering intraarticular steroid to the glenohumeral joint: landmark based (also called blind), ultrasound guided, and fluoroscopy guided. Input data on cost, probability, and utility estimates were obtained through a comprehensive literature search and from expert opinion. The primary effectiveness outcome was quality-adjusted life years (QALY). Costs were estimated in 2017 U.S. dollars. RESULTS: Ultrasound-guided injections were the dominant strategy for the base case, because it was the least expensive ($1280) and most effective (0.4096 QALY) strategy of the three options overall. The model was sensitive to the probabilities of getting the steroid into the joint by means of blind, ultrasound-guided, and fluoroscopy-guided techniques and to the costs of the ultrasound-guided and blind techniques. Two-way sensitivity analyses showed that ultrasound-guided injections were favored over blind and fluoroscopy-guided injections over a range of reasonable probabilities and costs. Probabilistic sensitivity analysis showed that ultrasound-guided injections were cost-effective in 44% of simulations, compared with 34% for blind injections and 22% for fluoroscopy-guided injections and over a wide range of willingness-to-pay thresholds. CONCLUSION: Ultrasound-guided injections are the most cost-effective option for the initial steroid-based treatment of patients with adhesive capsulitis. Blind and fluoroscopy-guided injections can also be cost-effective when performed by a clinician likely to accurately administer the medication into the correct location.
Assuntos
Bursite/tratamento farmacológico , Análise Custo-Benefício , Fluoroscopia/economia , Injeções Intra-Articulares/economia , Dor de Ombro/tratamento farmacológico , Esteroides/administração & dosagem , Esteroides/economia , Ultrassonografia de Intervenção/economia , Pontos de Referência Anatômicos , Bursite/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Dor de Ombro/diagnóstico por imagem , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Fluid samples obtained from an affected joint still play a central role in the diagnosis of periprosthetic joint infection (PJI). It is the only preoperative test able to discover the causative microbiological agent. In the hip, fluid aspiration can be performed through fluoroscopy, ultrasound, or, less commonly, computed tomography. However, there is still a lack of consensus on which method is preferable in terms of efficacy and costbenefit. PURPOSES: We, therefore, asked whether (1) the benefits in terms of sensitivity and specificity and (2) the costs were comparable between fluoroscopy- and ultrasound-guided joint aspirations in a suspicious of hip PJI. METHODS: Between 2013 and 2016, 52 hip aspirations were performed on 49 patients with clinical, radiological, or serological suspicion of PJI, waiting for a revision surgery. The patients were divided in two groups: fluoroscopy- (n = 26) vs ultrasound-guided hip aspiration group (n = 26). These groups were also divided in control and infected patients. The criteria of MusculoSkeletal Infection Society (MSIS) were used, as gold standard, to define PJI. RESULTS: (1) Ultrasound-guided aspiration revealed valid sensitivity (89% vs 60%) and specificity (94% vs 81%) in comparison with fluoroscopic-guided aspiration. (2) The cost analysis was also in favor of ultrasound-guided aspiration (125.30) than fluoroscopic-guided aspiration (343.58). CONCLUSIONS: We concluded that ultrasound-guided hip aspiration could represent a valid, safe, and less expensive diagnostic alternative to fluoroscopic-guided aspiration in hip PJI.
Assuntos
Fluoroscopia , Prótese de Quadril , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Sucção/métodos , Cirurgia Assistida por Computador , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Custos e Análise de Custo , Feminino , Fluoroscopia/economia , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Sucção/economia , Cirurgia Assistida por Computador/economia , Ultrassonografia/economiaRESUMO
OBJECTIVE The cost of spine management is rising. As diagnostic imaging accounts for approximately 10% of total patient care spending, there is interest in determining if economies could be made with regard to the routine consultation of radiology for image interpretation. In the context of spine trauma, both the spine surgeon and the radiologist interpret perioperative imaging. Authors of the present study investigated the impact of radiologist interpretation of perioperative imaging from patients with traumatic single-level thoracolumbar fractures given that spine surgeons are expected to be comfortable interpreting pathologies of the musculoskeletal system. METHODS The authors conducted a retrospective review of all patients presenting with a single-level thoracolumbar fracture treated at the McGill University Health Centre in the period from January 2003 to December 2010. The time between image capture and radiologist interpretation as well as the number of extraskeletal and/or incidental findings was extracted from the radiology reports on all perioperative images including radiographic, fluoroscopic, and CT images. The cost of interpretation was obtained from the provincial health insurance entity of Quebec. RESULTS Eighty-two patients met the study inclusion criteria. Radiologists took a median of 1 day (IQR 0-5.5 days) to interpret preoperative radiographs. Intraoperative fluoroscopic images and postoperative radiographs were read by the radiologist a median of 19 days (IQR 4-56.75 days) and 34 days (IQR 1-137.5 days) after capture, respectively (p < 0.05). Preoperative radiologist dictations reported extraskeletal and/or incidental findings for 8.1% of radiographs; there were no intraoperative or postoperative extraskeletal findings beyond those previously reported on the preoperative radiographs. Radiologists took a median of 1 day (IQR 0-1 day) to read both preoperative and postoperative CT scans; extraskeletal and/or incidental findings were present in 46.2% of preoperative reports and 4.5% of postoperative reports. There were no intraoperative or postoperative radiological findings that provoked reoperation. A total of 66 intraoperative fluoroscopy images and 225 postoperative radiographs were read for a cost of $1399.20 and $1867.50 (Canadian dollars), respectively, for radiologist interpretation. This cost amounted to 40.3% of all perioperative image interpretation spending. CONCLUSIONS In the management of single-level thoracolumbar fractures, radiologists add information to the diagnostic picture when interpreting preoperative radiographs and perioperative CT scans; however, the interpretation of intraoperative fluoroscopic images and postoperative radiographs comes with significant delay, does not add additional information, and represents an area of potential cost and professional-resource reduction.
Assuntos
Vértebras Lombares/lesões , Assistência Perioperatória/economia , Radiologistas/economia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/economia , Vértebras Torácicas/lesões , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Feminino , Fluoroscopia/economia , Humanos , Achados Incidentais , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Cirurgiões/economia , Vértebras Torácicas/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X/economia , Adulto JovemRESUMO
BACKGROUND: Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs. METHODS: We conducted a retrospective review of a prospectively collected database that included 200 patients who underwent LSG for severe obesity between 2011 and 2014. Primary outcome measures were the incidence of staple line leaks and the results of Gastrografin swallow tests. We obtained imaging costs from appropriate hospital departments. RESULTS: Gastrografin swallow was obtained on postoperative day 1 for all 200 patients who underwent LSG. Three patients (1.5%) were found to have staple line leaks. Gastrograffin swallows yielded 1 true positive result and 2 false negatives. The false negatives were subsequently diagnosed on computed tomography (CT) scan. The sensitivity of Gastrografin swallow in this study was 33%. For 200 patients, the total direct cost of the Gastrografin swallows was $35 000. CONCLUSION: The use of routine upper gastrointestinal contrast studies for early detection of staple line leaks has low sensitivity and is costly. We recommend selective use of CT instead.
CONTEXTE: Même si la gastrectomie longitudinale par laparoscopie (GLL) s'est révélée sûre et efficace pour le traitement de l'obésité sévère (indice de masse corporelle ≥ 35), les fuites survenant à la ligne d'agrafes demeurent une complication majeure et sont responsables d'une bonne partie des complications et des décès associés à cette chirurgie. Plusieurs des centres effectuant des GLL procèdent au dépistage systématique des fuites à la ligne d'agrafes en réalisant des tests avec des agents de contraste le jour suivant la chirurgie. Nous avons évalué l'utilité du test à la gastrografine comme méthode de dépistage précoce des fuites à la ligne d'agrafes au jour 1, ainsi que les coûts qui y sont associés. MÉTHODES: Nous avons mené une étude rétrospective à partir d'une base de données créée de façon prospective qui portait sur 200 patients ayant subi une GLL entre 2011 et 2014 en raison d'une obésité sévère. Les principaux indicateurs de résultats étaient l'incidence de fuites à la ligne d'agrafes et les résultats obtenus aux tests à la gastrografine. Les renseignements sur le coût des tests d'imagerie nous ont été fournis par les départements appropriés des hôpitaux. RÉSULTATS: Selon les résultats des tests à la gastrografine au jour 1 obtenus pour les 200 patients ayant subi une GLL, 3 patients (1,5 %) présentaient des fuites à la ligne d'agrafes. Il s'agissait en réalité d'un vrai positif et 2 faux négatifs. Le diagnostic des faux négatifs a ensuite été effectué par tomographie par ordinateur. La sensibilité du test à la gastrografine était donc de 33 % au cours de cette étude. Le coût total de ce test, pour les 200 patients, était de 35 000 $. CONCLUSION: Le recours à des examens systématiques du tractus gastro-intestinal supérieur au moyen d'agents de contraste pour le dépistage précoce des fuites à la ligne d'agrafes a une faible sensibilité et est associé à des coûts élevés. Nous recommandons plutôt l'utilisation sélective de la tomographie par ordinateur.
Assuntos
Meios de Contraste , Diatrizoato de Meglumina , Fluoroscopia/normas , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Grampeamento Cirúrgico/efeitos adversos , Adulto , Endoscopia Gastrointestinal , Feminino , Fluoroscopia/economia , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de TempoRESUMO
BACKGROUND: Mini C-arm image intensifiers (IIs) are promoted to permit lower radiation dose than traditional IIs with a lower purchase price and without the need for a radiographer, saving time. In real-world usage, radiation dose is not always lower. METHODS: A retrospective review of prospectively collected data for 620 children undergoing forearm fracture reduction in theatre was undertaken. Imaging was performed with the Fluoroscan mini C-arm or a comparison traditional II. Radiation dose and theatre time were recorded. RESULTS: There was no significant difference in radiation dose as measured by dose-area product (0.013 versus 0.014 Gy.cm2 , P = 0.22). We noted an inverse association between operator experience and radiation dose. The mini C-arm allowed a shorter procedure time (26 versus 30 min, P < 0.001) and theatre time (13 versus 16 min, P < 0.001). Re-displacement rates were similar (1.3 versus 2.2%). The Fluoroscan is AU$120 000 cheaper to purchase and AU$35 283 cheaper to run per year than the comparison II. Consultants had a 14% lower dose-area product (0.012 versus 0.014 Gy.cm2 , P < 0.001) and 18% shorter screening time (8 versus 9.8 s, P < 0.001) than registrars. CONCLUSION: The Fluoroscan mini C-arm II does not demonstrate a radiation saving during closed reductions of paediatric forearm fractures but allows shorter procedures and theatre time with similar re-displacement rates. The purchase price is lower than a traditional II. We noted that operator experience reduces radiation dose.
Assuntos
Fluoroscopia/instrumentação , Traumatismos do Antebraço/diagnóstico por imagem , Exposição à Radiação/análise , Austrália , Criança , Feminino , Fluoroscopia/economia , Fluoroscopia/métodos , Traumatismos do Antebraço/cirurgia , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pediatria/instrumentação , Pediatria/métodos , Doses de Radiação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: To examine the cost factors associated with ultrasound and fluoroscopic guidance for percutaneous nephrolithotomy (PCNL) and to determine which method can be performed at a lower cost per case. METHODS: A cost comparison study was performed utilizing clinical data from a prospectively maintained research database. We included the most recent 33 consecutive ultrasound-guided PCNL cases in 2016 and the most recent 40 consecutive fluoroscopy-guided PCNL cases before the operative surgeon transitioned to ultrasound guidance in May 2014. The total operative time and clinical outcomes were examined. Costs were extracted from the institution accounting systems and given a uniform multiplier to protect institutional financial reporting confidentiality. Comparisons were made using the Student t test and the chi-squared test. RESULTS: After excluding outliers, 71 PCNL procedures were included in the analysis. Demographic data and stone characteristics were not different between ultrasound-guided and fluoroscopy-guided groups. However, the mean operative time for ultrasound-guided PCNL was significantly shorter (99.8 ± 27.0 vs 144.9 ± 55.1 minutes, P < .05). When capital equipment costs were included, the mean total cost per case of ultrasound-guided PCNL was approximately 30% less than fluoroscopy-guided PCNL (simulated costs with a uniform multiplier; $5258.90 ± 957.12 vs $7508.60 ± 1163.83, P < .05). Postoperative clinical outcomes were comparable between the 2 groups. CONCLUSION: When capital costs are included, ultrasound-guided PCNL can produce comparable clinical outcomes to fluoroscopy-guided procedures at a lower cost to the institution. Shorter operative time drives significant savings with the adoption of ultrasound guidance, which may be magnified with increasing case volume. Using ultrasound imaging during PCNL may be more cost-effective compared to fluoroscopy and warrants further study.
Assuntos
Fluoroscopia/economia , Nefrolitotomia Percutânea/economia , Ultrassonografia , Centros Médicos Acadêmicos , Adulto , Idoso , Índice de Massa Corporal , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Duração da Cirurgia , Estudos Prospectivos , Raios XRESUMO
OBJECTIVES: Biceps tendinitis is a source of anterior shoulder pain and is amenable to therapeutic injection. Studies have shown greater accuracy with image-guided compared to unguided injection of the biceps tendon sheath. There is no literature comparing ultrasound-guided to fluoroscopy-guided biceps tendon sheath injection. The purpose of this study was to compare clinical outcomes, complication rates, procedure success rates, and financial costs of the two imaging-guided methods. METHODS: A 10-year retrospective review of the picture archiving and communication system was performed to identify patients who underwent image-guided proximal biceps tendon sheath injection. Two radiologists reviewed the picture archiving and communication system and clinical notes to record pain relief, complications, fluoroscopy time, first-pass success rate (defined as injection into the sheath on the first needle pass), final success rate (needle placement in the tendon sheath on the final needle pass), and average costs. RESULTS: Fifty fluoroscopy-guided and 53 ultrasound-guided cases were identified. There was no statistically significant difference in pain relief or complications. The first-pass success rate was 90.6% for ultrasound compared to 74.0% for fluoroscopy. The final-pass success rate was 98.2% for ultrasound versus 92.0% for fluoroscopy. The mean fluoroscopy time was 57.6 seconds. Ultrasound showed preinjection abnormalities of the biceps tendon in 47.5% of cases. CONCLUSIONS: Compared to fluoroscopy-guided biceps tendon sheath injection, ultrasound had higher initial- and final-pass success rates, visualized abnormalities before injection, and had similar pain relief and complication rates. Ultrasound is more accurate and has greater diagnostic benefits than unguided or fluoroscopy-guided biceps tendon sheath injection.
Assuntos
Tendinopatia/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia/economia , Fluoroscopia/métodos , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tendinopatia/diagnóstico por imagem , Tendões/diagnóstico por imagem , Tendões/efeitos dos fármacos , Resultado do Tratamento , Ultrassonografia de Intervenção/economia , Adulto JovemRESUMO
BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (TLIF) has undergone significant evolution since its conception as a fusion technique to treat lumbar spondylosis. Minimally invasive TLIF is commonly performed using intraoperative two-dimensional fluoroscopic x-rays. However, intraoperative computed tomography (CT)-based navigation during minimally invasive TLIF is gaining popularity for improvements in visualizing anatomy and reducing intraoperative radiation to surgeons and operating room staff. This is the first study to compare clinical outcomes and cost between these 2 imaging techniques during minimally invasive TILF. METHODS: For comparison, 28 patients who underwent single-level minimally invasive TLIF using fluoroscopy were matched to 28 patients undergoing single-level minimally invasive TLIF using CT navigation based on race, sex, age, smoking status, payer type, and medical comorbidities (Charlson Comorbidity Index). The minimum follow-up time was 6 months. The 2 groups were compared in regard to clinical outcomes and hospital reimbursement from the payer perspective. RESULTS: Average surgery time, anesthesia time, and hospital length of stay were similar for both groups, but average estimated blood loss was lower in the fluoroscopy group compared with the CT navigation group (154 mL vs. 262 mL; P = 0.016). Oswestry Disability Index, back visual analog scale, and leg visual analog scale scores similarly improved in both groups (P > 0.05) at 6-month follow-up. Cost analysis showed that average hospital payments were similar in the fluoroscopy versus the CT navigation groups ($32,347 vs. $32,656; P = 0.925) as well as payments for the operating room (P = 0.868). CONCLUSIONS: Single minimally invasive TLIF performed with fluoroscopy versus CT navigation showed similar clinical outcomes and cost at 6 months.
Assuntos
Fluoroscopia/economia , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Fusão Vertebral/economia , Espondilose/economia , Espondilose/cirurgia , Cirurgia Assistida por Computador/economia , Tomografia Computadorizada por Raios X/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Prevalência , Espondilose/epidemiologia , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: The aim of the study was to compare the efficacy of the laser lithotripter with the ultrasonic lithotripter in mini percutaneous nephrolithotomy (miniperc). MATERIAL AND METHODS: From June 2013 to January 2014; medical records of 77 consecutive patients who underwent miniperc operation were retrospectively evaluated. Ultrasonic lithotripter was used in 22 patients (Group 1), while laser was used in 55 patients. In the laser group, 22 patients were randomly selected who had same characteristics compared to group 1 (Group 2). Success rate, total operative time, complications according to modified Clavien classification, fluoroscopy time, haemoglobin drop, hospital stays and cost analysis were assessed. Success rates were evaluated on the second postoperative day and after the first month. RESULTS: Total operative time (p = 0.635) and fluoroscopy time (p = 0.248) were not significantly different between the two groups. In the laser group, the success rate (81.8%) was notably more than in the ultrasonic lithotripter group (68.2%) but there was no statistically significance (p = 0.296). Ten reusable ultrasonic probe were used for 22 patients, due to thinness and sensitiveness of the probe. Conversely, one single laser fiber (550 micron) was used for 22 patients. When the cost analysis of lithotripsy was considered, the cost per case was 190 dollar in group 1 and 124 dollar in group 2. (p = 0.154) Complication rate, hospital stay and haemoglobin drop were similar in both groups. CONCLUSION: Laser lithotripsy seems to be more cost effective than ultrasonic lithotripsy for miniperc but larger number of patients are required to confirm this estimation.
Assuntos
Cálculos Renais/terapia , Litotripsia a Laser , Nefrostomia Percutânea , Duração da Cirurgia , Ultrassom , Idoso , Análise Custo-Benefício , Fluoroscopia/economia , Seguimentos , Humanos , Cálculos Renais/economia , Cálculos Renais/cirurgia , Tempo de Internação/economia , Litotripsia a Laser/economia , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/economia , Estudos Retrospectivos , Resultado do Tratamento , Turquia , Ultrassom/economiaRESUMO
BACKGROUND CONTEXT: Pedicle screws are routinely used in contemporary spinal surgery. Screw misplacement may be asymptomatic but is also correlated with potential adverse events. Computer-assisted surgery (CAS) has been associated with improved screw placement accuracy rates. However, this technology has substantial acquisition and maintenance costs. Despite its increasing usage, no rigorous full economic evaluation comparing this technology to current standard of care has been reported. PURPOSE: Medical costs are exploding in an unsustainable way. Health economic theory requires that medical equipment costs be compared with expected benefits. To answer this question for computer-assisted spinal surgery, we present an economic evaluation looking specifically at symptomatic misplaced screws leading to reoperation secondary to neurologic deficits or biomechanical concerns. STUDY DESIGN/SETTING: The study design was an observational case-control study from prospectively collected data of consecutive patients treated with the aid of CAS (treatment group) compared with a matched historical cohort of patients treated with conventional fluoroscopy (control group). PATIENT SAMPLE: The patient sample consisted of consecutive patients treated surgically at a quaternary academic center. OUTCOME MEASURES: The primary effectiveness measure studied was the number of reoperations for misplaced screws within 1 year of the index surgery. Secondary outcome measures included were total adverse event rate and postoperative computed tomography usage for pedicle screw examination. METHODS: A patient-level data cost-effectiveness analysis from the hospital perspective was conducted to determine the value of a navigation system coupled with intraoperative 3-D imaging (O-arm Imaging and the StealthStation S7 Navigation Systems, Medtronic, Louisville, CO, USA) in adult spinal surgery. The capital costs for both alternatives were reported as equivalent annual costs based on the annuitization of capital expenditures method using a 3% discount rate and a 7-year amortization period. Annual maintenance costs were also added. Finally, reoperation costs using a micro-costing approach were calculated for both groups. An incremental cost-effectiveness ratio was calculated and reported as cost per reoperation avoided. Based on reoperation costs in Canada and in the United States, a minimal caseload was calculated for the more expensive alternative to be cost saving. Sensitivity analyses were also conducted. RESULTS: A total of 5,132 pedicle screws were inserted in 502 patients during the study period: 2,682 screws in 253 patients in the treatment group and 2,450 screws in 249 patients in the control group. Overall accuracy rates were 95.2% for the treatment group and 86.9% for the control group. Within 1 year post treatment, two patients (0.8%) required a revision surgery in the treatment group compared with 15 patients (6%) in the control group. An incremental cost-effectiveness ratio of $15,961 per reoperation avoided was calculated for the CAS group. Based on a reoperation cost of $12,618, this new technology becomes cost saving for centers performing more than 254 instrumented spinal procedures per year. CONCLUSIONS: Computer-assisted spinal surgery has the potential to reduce reoperation rates and thus to have serious cost-effectiveness and policy implications. High acquisition and maintenance costs of this technology can be offset by equally high reoperation costs. Our cost-effectiveness analysis showed that for high-volume centers with a similar case complexity to the studied population, this technology is economically justified.
Assuntos
Tomografia Computadorizada de Feixe Cônico/economia , Análise Custo-Benefício , Fluoroscopia/economia , Procedimentos Neurocirúrgicos/métodos , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Fluoroscopia/métodos , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/economia , Parafusos Pediculares/efeitos adversos , Parafusos Pediculares/economia , Reoperação/economia , Reoperação/estatística & dados numéricos , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/economiaRESUMO
We present a unique application of the gold fiducial as a preoperative, radiographic marker placed in the thoracic spine and used for intraoperative localization. In comparison to percutaneous vertebroplasty marking of thoracic spinal levels with polymethyl methacrylate (PMMA) cement, implantation of the gold fiducial is technically facile with a minimal learning curve. The fiducial markers are also associated with significantly less financial resources. Following 2013 Current Procedural Terminology (CPT) coding, the cost of vertebroplasty under fluoroscopic guidance, $3195·43, or under computed tomography (CT) guidance, $3232·54, is more than double the cost of the gold fiducial implantation - $1237·55 and $1267·03, under similar imaging techniques, respectively. In the first description of gold fiducials in the thoracic spine, we conclude that the marker is a safe and cost-effective method for preoperative localization of the thoracic levels.
Assuntos
Marcadores Fiduciais/economia , Compostos de Ouro/economia , Vértebras Torácicas/patologia , Embolização Terapêutica/economia , Embolização Terapêutica/métodos , Fluoroscopia/economia , Fluoroscopia/métodos , Humanos , Polimetil Metacrilato/economia , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/métodos , Vertebroplastia/economia , Vertebroplastia/métodosRESUMO
BACKGROUND: Despite the standardization of laparoscopic cholecystectomy (LC), the rate of bile duct injury (BDI) has risen from 0.2 to 0.5%. Routine use of intraoperative cholangiography (IOC) has not been widely accepted because of its cost and a lack of evidence concerning its use in preventing BDI. Fluorescent cholangiography (FC), which has recently been advocated as an alternative to IOC, is a novel intraoperative procedure involving infrared visualization of the biliary structures. This study evaluated costs and effectiveness of routinely implemented FC and IOC during LC. MATERIALS AND METHODS: Between February and June 2013, the authors prospectively collected the data of all patients undergoing laparoscopic cholecystectomy. We retrospectively reviewed and compared the use of FC and IOC. Procedure time, procedure cost, and effectiveness of the two methods were analyzed and compared. The surgeons involved in the cases completed a survey on the usefulness of each method. RESULTS: A total of 43 patients (21 males and 22 females) were analyzed during the study period. Mean age was 49.53 ± 14.35 years and mean body mass index was 28.35 ± 8 kg/m(2). Overall mean operative time was 64.95 ± 17.43 min. FC was faster than IOC (0.71 ± 0.26 vs. 7.15 ± 3.76 min; p < 0.0001). FC was successfully performed in 43 of 43 cases (100%) and IOC in 40 of 43 cases (93.02%). FC was less expensive than IOC (US$14.10 ± 4.31 vs. US$778.43 ± 0.40; p < 0.0001). According to the survey, all surgeons found routine use of FC useful. CONCLUSION: In this study, FC was effective in delineating important anatomic structures. It required less time and expense than IOC, and was perceived by the surgeons to be easier to perform, and at least as useful as IOC. Further prospective studies are warranted to evaluate the effectiveness of FC in decreasing BDI.
Assuntos
Colangiografia/economia , Colecistectomia Laparoscópica/economia , Fluoroscopia/economia , Monitorização Intraoperatória/economia , Cirurgia Assistida por Computador/economia , Doenças dos Ductos Biliares/economia , Doenças dos Ductos Biliares/cirurgia , Ductos Biliares/lesões , Ductos Biliares/cirurgia , Análise Custo-Benefício , Custos e Análise de Custo , Feminino , Florida , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
PURPOSE: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. MATERIALS AND METHODS: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40âmg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. RESULTS: The mean intervention time was 24.9 min. (range: 12â-â36âmin.) for MRI-guided infiltration and 19.7âmin. (range: 5â-â54âmin.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. CONCLUSION: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance.
Assuntos
Anti-Inflamatórios/administração & dosagem , Injeções Espinhais/economia , Imagem por Ressonância Magnética Intervencionista/economia , Radiculopatia/tratamento farmacológico , Radiculopatia/economia , Radiografia Intervencionista/economia , Raízes Nervosas Espinhais/efeitos dos fármacos , Tomografia Computadorizada por Raios X/economia , Triancinolona Acetonida/administração & dosagem , Adulto , Idoso , Custos e Análise de Custo , Feminino , Fluoroscopia/economia , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economiaRESUMO
OBJECTIVES: To compare the costs of CT- and MR-guided lumbosacral nerve root infiltration for minimally invasive treatment of low back pain and radicular pain. METHODS: Ninety patients (54 men, 36 women; mean age, 45.5 ± 12.8 years) underwent MR-guided single-site periradicular lumbosacral nerve root infiltration with 40 mg of triamcinolone acetonide. A further 91 patients (48 men, 43 women; mean age, 59.1 ± 13.8 years) were treated under CT fluoroscopy guidance. Prorated costs of equipment use (purchase, depreciation and maintenance), staff costs based on involvement times and expenditure for disposables were identified for MR- and CT-guided procedures. RESULTS: Mean intervention time was 20.6 min (14-30 min) for MR-guided and 14.3 min (7-32 min) for CT-guided treatment. The average total costs per patient were 177 for MR-guided and 88 for CT-guided interventions. These consisted of (MR/CT guidance) 93/29 for equipment use, 43/35 for staff and 41/24 for disposables. CONCLUSIONS: Lumbosacral nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. Given the advantages of no radiation exposure and possible future decrease in prices for MRI devices and MR-compatible injection needles, MR-guided nerve root infiltration may become a promising alternative to the CT-guided procedure. KEY POINTS: ⢠MR-guided nerve root infiltration therapy is now technically and clinically established. ⢠Costs using MRI guidance are still about double those for CT guidance. ⢠MR guidance involves no radiation exposure to patients and personnel. ⢠MR-guided nerve root infiltration may become a promising alternative to CT.
Assuntos
Fluoroscopia/economia , Dor Lombar/diagnóstico , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética/economia , Raízes Nervosas Espinhais/patologia , Tomografia Computadorizada por Raios X/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Custos de Cuidados de Saúde , Humanos , Dor Lombar/economia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Enteral feeding tube placement has been performed by nurses, gastroenterologists using endoscopy, and interventional radiologists. We hypothesized that midlevel providers placed feeding tubes at bedside using fluoroscopy safely, rapidly, and cost-effectively. METHODS: We retrospectively analyzed bedside feeding tube placement under fluoroscopy by trained nurse practitioners. We compared charges for this method with charges for placement by other practitioners. RESULTS: Nurse practitioners placed 632 feeding tubes in 462 patients. Three hundred seventy-nine placements took place in mechanically ventilated placements. Ninety-seven percent of tubes were positioned past the pylorus. The mean fluoroscopy time was 0.7 ± 1.2 minutes. The mean procedure time was 7.0 ± 5.1 minutes. All tubes were placed within 24 hours of the request. There were no complications. Institutional charges for tube placement were $149 for nurse practitioners, $226 for gastroenterologists, and $328 for interventional radiologists. CONCLUSIONS: The placement of feeding tubes under fluoroscopy by nurse practitioners is safe, timely, and cost-effective.
Assuntos
Nutrição Enteral/enfermagem , Intubação Gastrointestinal/enfermagem , Profissionais de Enfermagem , Análise Custo-Benefício , Nutrição Enteral/economia , Nutrição Enteral/instrumentação , Nutrição Enteral/métodos , Feminino , Fluoroscopia/economia , Fluoroscopia/enfermagem , Preços Hospitalares , Humanos , Intubação Gastrointestinal/economia , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/métodos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios , Fatores de Tempo , UtahRESUMO
BACKGROUND: This technical report describes a durable, low-cost, anatomically accurate, and easy-to-prepare combined ultrasound (US) and fluoroscopic phantom of the cervical spine. This phantom is meant to augment training in US- and fluoroscopic-guided pain medicine procedures. METHODS: The combined US and fluoroscopic phantom (CUF-P) is prepared from commercially available liquid plastic that is ordinarily used to prepare synthetic fishing lures. The liquid plastic is heated and then poured into a metal canister that houses an anatomical cervical spine model. Drops of dark purple dye are added to make the phantom opaque. After cooling, tubing is attached to the CUF-P to simulate blood vessels. RESULTS: The CUF-P accurately simulates human tissue by imitating both the tactile texture of skin and the haptic resistance of human tissue as the needle is advanced. This phantom contains simulated fluid-filled vertebral arteries that exhibit pulsed flow under color Doppler US. Under fluoroscopic examination, the CUF-P-simulated vertebral arteries also exhibit uptake of contrast dye if mistakenly injected. CONCLUSIONS: The creation of a training phantom allows the pain physician to practice needle positioning technique while simultaneously visualizing both targeted and avoidable vascular structures under US and fluoroscopic guidance. This low-cost CUF-P is easy to prepare and is reusable, making it an attractive alternative to current homemade and commercially available phantom simulators.