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J Reconstr Microsurg 2018; 34(01): 071-076
DOI: 10.1055/s-0037-1606540
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Linden K. Head
1   Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada
,
Douglas R. McKay
2   Division of Plastic Surgery, Queen's University, Kingston, Ontario, Canada
› Institutsangaben
Weitere Informationen

Publikationsverlauf

29. Mai 2017

31. Juli 2017

Publikationsdatum:
25. September 2017 (online)

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Abstract

Background Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis.

Methods Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses.

Results For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses.

Conclusion Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.

Keywords

microvascular anastomotic coupling device (MACD) - microsurgery - economics

Note

The study was presented at Plastic Surgery The Meeting 2015, October 16–20, 2015 in Boston, MA. A similar study focusing on the economics in a Canadian context was presented at the Canadian Society of Plastic Surgeons Annual Meeting, June 2–6, 2015 in Victoria, BC.


Disclaimer

This study exclusively uses published/publicly reported data and is exempt from Institutional Review Board approval under the Tri-Council Policy Statement: Ethical Conduct of Research Involving Humans, 2nd edition (TCPS 2).


Financial Disclosures

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.


Products referenced

– GEM Microvascular Anastomotic COUPLER System were retrieved from Synovis Micro Companies Alliance Incorporated (Birmingham, AL)


– 8–0, Nylon, ETHILON, monofilament suture (Ethicon Endo-Surgery Incorporated; Cornelia, Georgia, GA)


Authorship

Both authors contributed equally in conception, analysis, interpretation, and the drafting and revision of the manuscript.


 

  • References

  • 1 Androsov PI. New method of surgical treatment of blood vessel lesions. AMA Arch Surg 1956; 73 (06) 902-910
    CrossrefPubMedSuche in Google Scholar
  • 2 Ostrup LT, Berggren A. The UNILINK instrument system for fast and safe microvascular anastomosis. Ann Plast Surg 1986; 17 (06) 521-525
    CrossrefPubMedSuche in Google Scholar
  • 3 Gilbert RW, Ragnarsson R, Berggren A, Ostrup L. Strength of microvascular anastomoses: comparison between the unilink anastomotic system and sutures. Microsurgery 1989; 10 (01) 40-46
    CrossrefPubMedSuche in Google Scholar
  • 4 Berggren A, Ostrup LT, Lidman D. Mechanical anastomosis of small arteries and veins with the unilink apparatus: a histologic and scanning electron microscopic study. Plast Reconstr Surg 1987; 80 (02) 274-283
    CrossrefPubMedSuche in Google Scholar
  • 5 Ragnarsson R, Berggren A, Ostrup LT, Franzén L. Microvascular anastomosis of interpositional vein grafts with the UNILINK system. A comparative experimental study. Scand J Plast Reconstr Surg Hand Surg 1989; 23 (01) 23-28
    PubMedSuche in Google Scholar
  • 6 Nylander G, Ragnarsson R, Berggren A, Ostrup LT. The UNILINK system for mechanical microvascular anastomosis in hand surgery. J Hand Surg Am 1989; 14 (01) 44-48
    CrossrefPubMedSuche in Google Scholar
  • 7 Gardiner MD, Nanchahal J. Strategies to ensure success of microvascular free tissue transfer. J Plast Reconstr Aesthet Surg 2010; 63 (09) e665-e673
    CrossrefPubMedSuche in Google Scholar
  • 8 Grewal AS, Erovic B, Strumas N, Enepekides DJ, Higgins KM. The utility of the microvascular anastomotic coupler in free tissue transfer. Can J Plast Surg 2012; 20 (02) 98-102
    CrossrefPubMedSuche in Google Scholar
  • 9 Jandali S, Wu LC, Vega SJ, Kovach SJ, Serletti JM. 1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction. Plast Reconstr Surg 2010; 125 (03) 792-798
    CrossrefPubMedSuche in Google Scholar
  • 10 Vega S, Smartt Jr JM, Jiang S. , et al. 500 Consecutive patients with free TRAM flap breast reconstruction: a single surgeon's experience. Plast Reconstr Surg 2008; 122 (02) 329-339
    CrossrefPubMedSuche in Google Scholar
  • 11 Rozen WM, Whitaker IS, Acosta R. Venous coupler for free-flap anastomosis: outcomes of 1,000 cases. Anticancer Res 2010; 30 (04) 1293-1294
    PubMedSuche in Google Scholar
  • 12 Drucker PF. Management Challenges for the 21st Century. New York: Harper Business; 2001
    Suche in Google Scholar
  • 13 Phillips J. . US Medical Care Cost Inflation. J. C. Phillips. http://www.forecast-chart.com/about.html . Published 2014
    PubMed
  • 14 Heinz TR, Cowper PA, Levin LS. Microsurgery costs and outcome. Plast Reconstr Surg 1999; 104 (01) 89-96
    CrossrefPubMedSuche in Google Scholar
  • 15 Chang KP, Lin SD, Lai CS. Clinical experience of a microvascular venous coupler device in free tissue transfers. Kaohsiung J Med Sci 2007; 23 (11) 566-572
    CrossrefPubMedSuche in Google Scholar
  • 16 Spector JA, Draper LB, Levine JP, Ahn CY. Routine use of microvascular coupling device for arterial anastomosis in breast reconstruction. Ann Plast Surg 2006; 56 (04) 365-368
    CrossrefPubMedSuche in Google Scholar
  • 17 Sullivan SK, Dellacroce F, Allen R. Management of significant venous discrepancy with microvascular venous coupler. J Reconstr Microsurg 2003; 19 (06) 377-380
    Thieme ConnectPubMedSuche in Google Scholar
  • 18 Denk MJ, Longaker MT, Basner AL, Glat PM, Karp NS, Kasabian AK. Microsurgical reconstruction of the lower extremity using the 3M microvascular coupling device in venous anastomoses. Ann Plast Surg 1995; 35 (06) 601-606
    CrossrefPubMedSuche in Google Scholar
  • 19 Ahn CY, Shaw WW, Berns S, Markowitz BL. Clinical experience with the 3M microvascular coupling anastomotic device in 100 free-tissue transfers. Plast Reconstr Surg 1994; 93 (07) 1481-1484
    CrossrefPubMedSuche in Google Scholar
  • 20 Sasson HN, Stofman GM, Berman P. Clinical use of the 3M 2.5 mm mechanical microcoupling device in free tissue transfer. Microsurgery 1994; 15 (06) 421-423
    CrossrefPubMedSuche in Google Scholar
  • 21 Zeebregts C, Acosta R, Bölander L, van Schilfgaarde R, Jakobsson O. Clinical experience with non-penetrating vascular clips in free-flap reconstructions. Br J Plast Surg 2002; 55 (02) 105-110
    CrossrefPubMedSuche in Google Scholar
  • 22 Cope C, Miller M, Langstein H. Technique and clinical experience of the Unilink/3M microvascular anastomotic coupling device in free flap surgery. Internet J Plast Surg 2014 1(1)
    PubMedSuche in Google Scholar
  • 23 Shindo ML, Costantino PD, Nalbone VP, Rice DH, Sinha UK. Use of a mechanical microvascular anastomotic device in head and neck free tissue transfer. Arch Otolaryngol Head Neck Surg 1996; 122 (05) 529-532
    CrossrefPubMedSuche in Google Scholar
  • 24 de Bruijn HPDE, Marck KW. Coupling the venous anastomosis: safe and simple. Microsurgery 1996; 17 (07) 414-416
    CrossrefPubMedSuche in Google Scholar
  • 25 Berggren A, Ostrup LT, Ragnarsson R. Clinical experience with the Unilink/3M Precise microvascular anastomotic device. Scand J Plast Reconstr Surg Hand Surg 1993; 27 (01) 35-39
    CrossrefPubMedSuche in Google Scholar
  • 26 DeLacure MD, Kuriakose MA, Spies AL. Clinical experience in end-to-side venous anastomoses with a microvascular anastomotic coupling device in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1999; 125 (08) 869-872
    CrossrefPubMedSuche in Google Scholar
  • 27 Ahmadi I, Herle P, Rozen WM, Leong J. One versus two venous anastomoses in microsurgical free flaps: a meta-analysis. J Reconstr Microsurg 2014; 30 (06) 413-418
    Thieme ConnectPubMedSuche in Google Scholar
  • 28 Strum DP, Vargas LG, May JH, Bashein G. Surgical suite utilization and capacity planning: a minimal cost analysis model. J Med Syst 1997; 21 (05) 309-322
    CrossrefPubMedSuche in Google Scholar
  • 29 Lagasse RS. Anesthesia safety: model or myth? A review of the published literature and analysis of current original data. Anesthesiology 2002; 97 (06) 1609-1617
    CrossrefPubMedSuche in Google Scholar
  • 30 Rebollo MH, Bernal JM, Llorca J, Rabasa JM, Revuelta JM. Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg 1996; 112 (04) 908-913
    CrossrefPubMedSuche in Google Scholar
  • 31 Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: a systematic review of blinded studies. Am J Med 2002; 112 (03) 219-225
    CrossrefPubMedSuche in Google Scholar
  • 32 Selber JC, Chang EI, Liu J. , et al. Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg 2012; 130 (04) 550e-557e
    CrossrefPubMedSuche in Google Scholar
  • 33 Hui KC, Zhang F, Shaw WW. , et al. Learning curve of microvascular venous anastomosis: a never ending struggle?. Microsurgery 2000; 20 (01) 22-24
    CrossrefPubMedSuche in Google Scholar
  • 34 Zdolsek J, Ledin H, Lidman D. Are mechanical microvascular anastomoses easier to learn than suture anastomoses?. Microsurgery 2005; 25 (08) 596-598
    CrossrefPubMedSuche in Google Scholar
  • 35 Macario A. What does one minute of operating room time cost?. J Clin Anesth 2010; 22 (04) 233-236
    CrossrefPubMedSuche in Google Scholar