Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications

Figures & data

Table 1 Population distribution in the investigated scenarios

Baseline scenario
Specialty	No. of surgical procedures	SSC occurrence rate	No. of patients developing SSC	No. of patients not developing SSC
General surgery	2,567	2.97%	76	2,491
Ob–gyn surgery	4,283	1.75%	75	4,208
Orthopedic surgery	381	6.37%	24	357
Cardiac surgery	521	2.76%	14	507
Other surgery	814	3.18%	26	788

Innovative scenario
Specialty	No. of surgical procedures	% antibiotic prophylaxis	% innovative device and antibiotic prophylaxis	% “to do nothing” strategy	SSC occurrence rate	% SSC avoided with the innovative device	No. of patients developing SSC	No. of patients not developing SSC
General surgery	2,567	85.31%	5.64%	9.05%	2.97%	80%	15	2,552
Ob–gyn surgery	4,283	86.91%	4.04%	9.05%	1.75%	50%	37	4,245
Orthopedic surgery	381	86.32%	4.63%	9.05%	6.37%	76%	6	375
Cardiac surgery	521	80.65%	10.30%	9.05%	2.76%	93%	1	520
Other surgery	814	84.80%	6.15%	9.05%	3.18%	75%	6	808

Abbreviations: SSC, surgical-site complication; ob–gyn, obstetrical–gynecological.

Table 2 Health care expenditure items

Health care expenditure items	Costs
General surgical procedure	€ 3,652.21
Ob–gyn surgical procedure	€ 1,089.64
Orthopedic surgical procedure	€ 3,448.67
Cardiac surgical procedure	€ 6,418.31
Other surgical procedure	€ 3,652.21
Antibiotic therapy (general surgery)	€ 6.38
Antibiotic therapy (ob–gyn surgery)	€ 5.82
Antibiotic therapy (orthopedic surgery)	€ 6.90
Antibiotic therapy (cardiac surgery)	€ 13.59
Antibiotic therapy (other surgery)	€ 8.17
Health care expenditure items	No SSC development	SSC development	Difference	Difference %
Length of stay	€ 5,034.38	€ 8,269.80	€ 3,235.42	64.27%
Laboratory exams and diagnostic procedures	€ 449.43	€ 639.22	€ 189.79	42.23%
Wound dressing (general surgery)	€ 46.53	€ 47.98	€ 1.45	3.12%
Wound dressing (ob–gyn surgery)	€ 46.53	€ 47.98	€ 1.45	3.12%
Wound dressing (orthopedic surgery)	€ 94.00	€ 125.00	€ 31.00	32.98%
Wound dressing (cardiac surgery)	€ 94.00	€ 125.00	€ 31.00	32.98%
Wound dressing (other surgery)	€ 70.27	€ 86.49	€ 16.22	23.08%

Abbreviation: ob–gyn, obstetrical–gynecological; SSC, surgical-site complication.

Table 3 Budget impact and scenario analyses

Budget impact analysis
	Baseline scenario	Innovative scenario	Difference	Difference %
General surgery	€ 23,851,754.50	€ 23,654,414.98	−€ 197,339.51	−0.83%
Ob–gyn surgery	€ 28,633,665.06	€ 28,520,834.39	−€ 112,830.67	−0.39%
Orthopedic surgery	€ 3,530,558.09	€ 3,465,948.43	−€ 64,609.65	−1.83%
Cardiac surgery	€ 6,306,584.47	€ 6,261,937.12	−€ 44,647.35	−0.71%
Other surgery	€ 7,591,908.03	€ 7,527,547.29	−€ 64,360.74	−0.85%
Total	€ 69,914,470.14	€ 69,430,682.22	−€ 483,787.92	−0.69%

Scenario analyses – modification of the SSC occurrence rate
Minimum scenario analysis	SSC occurrence rate	Patients developing an SSC – baseline scenario	Patients developing an SSC – innovative scenario	Baseline scenario	Innovative scenario	Difference	Difference %
General surgery	1.36%	35	7	€ 23,708,209.37	€ 23,625,705.96	−€ 82,503.41	−0.35%
Ob–gyn surgery	0.43%	18	9	€ 28,437,324.90	€ 28,422,664.31	−€ 14,660.59	−0.05%
Orthopedic surgery	1.14%	4	1	€ 3,459,757.04	€ 3,448,956.18	−€ 10,800.86	−0.31%
Cardiac surgery	2.18%	11	1	€ 6,295,857.95	€ 6,261,186.26	−€ 34,671.68	−0.55%
Other surgery	2.36%	19	5	€ 7,568,464.92	€ 7,521,686.51	−€ 46,778.41	−0.62%
Total				€ 69,469,614.18	€ 69,280,199.23	−€ 189,414.95	−0.27%
Maximum scenario analysis	SSC occurrence rate	Patients developing an SSC – baseline scenario	Patients developing an SSC – innovative scenario	Baseline scenario	Innovative scenario	Difference	Difference %
General surgery	4.62%	119	24	€ 23,998,865.96	€ 23,683,837.28	−€ 315,028.68	−1.31%
Ob–gyn surgery	4.38%	188	94	€ 29,024,857.96	€ 28,716,430.84	−€ 308,427.12	−1.06%
Orthopedic surgery	8.49%	32	8	€ 3,559,257.55	€ 3,472,836.31	−€ 86,421.25	−2.43%
Cardiac surgery	4.14%	22	2	€ 6,332,106.19	€ 6,263,723.64	−€ 68,382.55	−1.08%
Other surgery	4.02%	33	8	€ 7,615,922.92	€ 7,533,551.01	−€ 82,371.91	−1.08%
Total				€ 70,531,010.58	€ 69,670,379.08	−€ 860,631.51	−1.22%

Abbreviations: SSC, surgical-site complication; ob–gyn, obstetrical–gynecological.

Table 4 Scenario analyses

Scenario analyses – modification of the population distribution among the different prevention strategies
Minimum scenario analysis	% antibiotic prophylaxis in the innovative scenario	% innovative device and antibiotic prophylaxis in the innovative scenario	% “to do nothing” strategy in the innovative scenario	Baseline scenario	Innovative scenario	Difference	Difference %
General surgery	84.74%	6.21%	9.05%	€ 23,851,754.50	€ 23,655,866.53	−€ 195,887.96	−0.82%
Ob–gyn surgery	86.51%	4.44%	9.05%	€ 28,633,665.06	€ 28,522,543.37	−€ 111,121.69	−0.39%
Orthopedic surgery	85.86%	5.09%	9.05%	€ 3,530,558.09	€ 3,466,041.32	−€ 64,516.76	−1.83%
Cardiac surgery	79.62%	11.33%	9.05%	€ 6,306,584.47	€ 6,262,218.57	−€ 44,365.90	−0.70%
Other surgery	84.18%	6.77%	9.05%	€ 7,591,908.03	€ 7,527,928.57	−€ 63,979.46	−0.84%
Total				€ 69,914,470.14	€ 69,434,598.36	−€ 479,871.78	−0.69%
Maximum scenario analysis	% antibiotic prophylaxis in the innovative scenario	% innovative device and antibiotic prophylaxis in the innovative scenario	% “to do nothing” strategy in the innovative scenario	Baseline Scenario	Innovative Scenario	Difference €	Difference %
General surgery	85.31%	6.21%	8.48%	€ 23,851,754.50	€ 23,655,959.88	−€ 195,794.61	−0.82%
Ob–gyn surgery	86.91%	4.44%	8.65%	€ 28,633,665.06	€ 28,522,643.06	−€ 111,022.00	−0.39%
Orthopedic surgery	86.32%	5.09%	8.59%	€ 3,530,558.09	€ 3,466,053.43	−€ 64,504.66	−1.83%
Cardiac surgery	80.65%	11.33%	8.02%	€ 6,306,584.47	€ 6,262,291.49	−€ 44,292.98	−0.70%
Other surgery	84.80%	6.77%	8.44%	€ 7,591,908.03	€ 7,527,969.49	−€ 63,938.54	−0.84%
Total				€ 69,914,470.14	€ 69,434,917.35	−€ 479,552.79	−0.69%

Abbreviation: ob–gyn, obstetrical–gynecological.

Table 5 Organizational impact: the decrease in the length of stay

	Baseline scenario	Innovative scenario	Difference	Difference %
General surgery	24,587.72	24,221.76	−365.96	−1.49%
Ob–gyn surgery	40,706.07	40,481.23	−224.84	−0.55%
Orthopedic surgery	3,730.10	3,619.34	−110.76	−2.97%
Cardiac surgery	4,982.98	4,902.75	−80.23	−1.61%
Other surgery	7,807.99	7,691.49	−116.50	−1.49%
Total	81,814.86	80,916.57	−898.28	−1.10%
Minimum scenario analysis	Baseline scenario	Innovative scenario	Difference	Difference %
General surgery	24,339.75	24,172.17	−167.58	−0.69%
Ob–gyn surgery	40,366.89	40,311.64	−55.25	−0.14%
Orthopedic surgery	3,610.44	3,590.62	−19.82	−0.55%
Cardiac surgery	4,964.85	4,901.48	−63.37	−1.28%
Other surgery	7,767.93	7,681.47	−86.46	−1.11%
Total	81,049.86	80,657.39	−392.47	−0.48%
Maximum scenario analysis	Baseline scenario	Innovative scenario	Difference	Difference %
General surgery	24,841.86	24,272.59	−569.27	−2.29%
Ob–gyn surgery	41,381.86	40,819.13	−562.73	−1.36%
Orthopedic surgery	3,778.60	3,630.98	−147.62	−3.91%
Cardiac surgery	5,026.11	4,905.77	−120.34	−2.39%
Other surgery	7,849.02	7,701.74	−147.27	−1.88%
Total	82,877.46	81,330.22	−1,547.24	−1.87%

Abbreviation: ob–gyn, obstetrical–gynecological.

Table 6 Additional surgical procedures

	Average	Minimum	Maximum
General surgery	28	12	49
Ob–gyn surgery	47	21	81
Orthopedic surgery	4	2	7
Cardiac surgery	6	3	10
Other surgery	9	4	15
Total	95	41	163

Abbreviation: ob–gyn, obstetrical–gynecological.