Using outcomes data to justify instituting new technology: a single institution\u2019s experience

P M Starker,B Chinn

doi:10.1007/s00464-017-6001-3

Abstract

BackgroundThe PILLAR II trial demonstrated PINPOINT is safe, feasible to use with no reported adverse events and resulted in no anastomotic leaks in patients who had a change in surgical plan based on PINPOINT’s intraoperative assessment of tissue perfusion during colorectal resection. Whether the cost savings associated with this reduction in anastomotic complications can offset the cost of investing in PINPOINT is unknown.MethodsWe performed a retrospective analysis of all patients (N = 347) undergoing colectomy with primary anastomosis from January 2015 to April 2016. These patients were stratified based on whether fluorescence imaging was used intraoperatively. The clinical outcomes of these patients were then evaluated based on their development of an anastomotic leak or stricture. The direct hospital costs per case were then calculated, and the economic impact of using fluorescence imaging was examined to assess whether decreased direct costs would justify the initial expenditures to purchase new technology (PINPOINT System, NOVADAQ, Canada).ResultsFluorescence imaging in colorectal surgery using PINPOINT reduced the anastomotic failure rate in patients who underwent colon resection. The PINPOINT group (n = 238) had two (0.84%) anastomotic failures, while the non-PINPOINT group (n = 109) had six (5.5%) anastomotic failures. In the PINPOINT group, 11 (4.6%) patients had a change in the resection margin based on the results of the fluorescence imaging, and none of these patients experienced an anastomotic failure. Cost per case was less in the PINPOINT group secondary to fewer direct costs associated with complications.ConclusionsThese results validate the findings of the PILLAR II trial and confirm the decrease in direct costs due to reduction in anastomotic failures as a result of using PINPOINT justified the expense of the new technology after just 143 cases.

Highlights

The PILLAR II trial demonstrated PINPOINT is safe, feasible to use with no reported adverse events and resulted in no anastomotic leaks in patients who had a change in surgical plan based on PINPOINT’s intraoperative assessment of tissue perfusion during colorectal resection
Change in resection margin refers to the number of patients who were identified by PINPOINT to have insufficient perfusion of the bowel which was to be used for the anastomosis resulting in further resection
Patients who underwent PINPOINT intraoperative fluorescence imaging during their surgery experienced significantly lower anastomotic failure rates (Table 2) and cost less to treat (Table 6) compared to those who were not treated with PINPOINT

Summary

Study design

This was a retrospective analysis (clinical and financial) of all patients undergoing colectomy with anastomosis over a 15-month period to assess for anastomotic failure (leak or stricture). The anastomotic complications considered for this study were leaks and strictures Both were captured by performing individual chart reviews on all colorectal cases to screen for these postoperative occurrences. Change in resection margin refers to the number of patients who were identified by PINPOINT to have insufficient perfusion of the bowel which was to be used for the anastomosis resulting in further resection. Revision on anastomosis refers to the number of patients who were identified by PINPOINT to have insufficient perfusion of the bowel after the anastomosis was completed resulting in further resection. Additional resection margin is the amount of intestine resected to obtain bowel margins, as assessed by PINPOINT, with appropriate perfusion to perform a reliable anastomosis. The study compared patient demographics to ensure both groups were similar and to identify variables that were associated with or contributed to anastomotic leaks.

Results

Discussion

Limitations

Conclusion

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