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Risk-Based Economic Model for Closed Incision Negative Pressure Therapy Use after Open Spine Surgery
Kyle B Mueller1, Yuefeng Hou2, Karen Beach2
1Dept of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Background:
Surgical site infections (SSIs) and complications (SSCs) following open spine surgery result in substantial added healthcare system cost and reduced quality of care. Closed incision negative pressure therapy (ciNPT) is increasingly used as an adjunctive tactic, for postoperative management of high-risk closed incisions. We developed an economic model to evaluate potential savings from SSI and SSC-associated readmission (SSC-AR) reduction against the incremental acquisition cost of the ciNPT system across different patient risk levels.
Methods:
Patient risk parameters were derived from published predictive models for SSI and SSC-AR risk, using data from the Premier Healthcare Database of open spine surgeries. The economic model incorporated published average costs of SSIs ($18,899) and SSC-ARs ($22,698) within 90 days post-discharge in orthopedic surgery and an estimated ciNPT effectiveness rate ranging from 20% to 80% in spine surgery. Primary measure was estimated economic impact of preventing SSIs or SSC-ARs using ciNPT.
Results:
Cost savings were observed in populations with SSI/SSC-AR rates ≥15.0 when ciNPT was universally applied. ciNPT was not cost-effective for rates ≤0.5%. For rates between 1.0% and 15.0%, savings were observed depending on specific patient risk levels.
Conclusions:
Strategic use of ciNPT, guided by patient risk stratification, can provide cost savings for healthcare systems. This model may help surgeons to preoperatively identify spine surgery patients with the highest potential cost benefit from ciNPT.
