Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses

Area of Science:

• Microsurgery
• Surgical Devices
• Health Economics

Background:

• Microvascular anastomotic coupling devices (MACDs) demonstrate comparable flap survival and reduced operative times versus hand-sewn anastomoses.
• No prior economic analysis of MACDs has been published.
• This study aimed to economically compare coupler-assisted versus hand-sewn venous anastomoses.

Purpose of the Study:

• To conduct an economic analysis of venous anastomosis using a microvascular anastomotic coupling device (MACD) compared to traditional hand-sewn sutures.
• To evaluate the cost-effectiveness of coupler-assisted anastomoses in free tissue transfer procedures.

Main Methods:

• An activity-based cost analysis modeled fixed and variable costs for coupler-assisted (GEM COUPLER) and hand-sewn venous anastomoses.
• Disposable costs, capital expenditures, and operating room (OR) costs were quantified using supplier price lists and literature reviews.
• Operating time reductions associated with coupler-assisted anastomoses were assessed.

Main Results:

• Coupler-assisted anastomoses incurred higher disposable costs ($284.40 increase per anastomosis).
• A mean operative time reduction of 16.9 minutes with couplers decreased OR costs by $519.29 ($30.82 per minute).
• Each coupler-assisted anastomosis yielded total savings of $234.89, with capital expenditure recouped after 13 uses.

Conclusions:

• Microvascular anastomotic coupling devices (MACDs) generate cost savings per case and rapidly recover their capital expenditure compared to hand-sewn venous anastomoses.
• This economic analysis supports MACD purchasing decisions, especially for centers with lower surgical volumes.
• MACDs provide a practical economic benefit despite potential limitations.