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Volin J, Daniel J, Walter B, Herndon P, Tran D, Blumline J, Spillinger A, Karabon P, Fletcher C, Folbe A, Hafron J. Cost-effectiveness of routine type and screens in select urological surgeries. Int Urol Nephrol 2023; 55:823-833. [PMID: 36609935 DOI: 10.1007/s11255-022-03452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the cost-effectiveness of obtaining a preoperative type and screen (T/S) for common urologic procedures. METHODS A decision tree model was constructed to track surgical patients undergoing two preoperative blood ordering strategies as follows: obtaining a preoperative T/S versus not doing so. The model was applied to the National (Nationwide) Inpatient Sample (NIS) data, from January 1, 2006 to September 30, 2015. Cost estimates for the model were created from combined patient-level data with published costs of a T/S, type and crossmatch (T/C), a unit of pRBC, and one unit of emergency-release transfusion (ERT). The primary outcome was the incremental cost per ERT prevented, expressed as an incremental cost-effectiveness ratio (ICER) between the two preoperative blood ordering strategies. A cost-effectiveness analysis determined the ICER of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.00. RESULTS A total of 4,113,144 surgical admissions from 2006 to 2015 were reviewed. The overall transfusion rate was 10.54% (95% CI, 10.17-10.91) for all procedures. The ICER of preoperative T/S was $1500.00 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S. CONCLUSION Routine preoperative T/S for radical prostatectomy (rate = 3.88%) and penile implants (rate = .91%) does not represent a cost-effective practice for these surgeries. It is important for urologists to review their institution T/S policy to reduce inefficiencies within the preoperative setting.
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Affiliation(s)
- Joshua Volin
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Joshua Daniel
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Brianna Walter
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA.
| | - Patrick Herndon
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Deanna Tran
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - James Blumline
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Aviv Spillinger
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Craig Fletcher
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Adam Folbe
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Jason Hafron
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
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Tjaden A, Codispoti N, Yang LC, Pham T. Examining the Utility and Cost of Routine Type and Screen Prior to Minimally Invasive Hysterectomy. JSLS 2021; 25:JSLS.2021.00020. [PMID: 34354335 PMCID: PMC8325481 DOI: 10.4293/jsls.2021.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Pre-operative type and screen (T&S) is typically obtained if a patient is expected to require a blood transfusion; however, in cases of minimal blood loss, routine T&S may be unnecessary. The objective of our study was to examine the utility and cost of routine pre-operative T&S prior to minimally invasive hysterectomies (MIH). Methods: We performed a retrospective chart review of all MIH from January 1, 2018 to December 31, 2019. Patient demographics and surgical parameters were abstracted. The proportion of MIH with a preoperative T&S was compared to the rate of peri-operative blood transfusion. Statistical tests were used where appropriate. Logistic regression was used to examine the relationship between pre-operative hemoglobin (Hgb) and peri-operative transfusion. Results: Patients (n = 307) with a mean age of 54 (standard deviation = 12.6) underwent MIH. T&S was ordered in 42.7% of cases, with 2.9% requiring a blood transfusion. Two-thirds of women receiving a transfusion had a history of anemia (p = .004). Women with a pre-operative Hgb < 10.6 gm/dL (n = 30) had a 27% probability of a transfusion, while those with a pre-operative Hgb > 10.6 gm/dL (n = 264) had a 99% probability of no transfusion. A T&S costs ∼$190 at our institution; if routine T&S was eliminated prior to MIH, cost savings is projected to be ∼$11,590 annually. Conclusion: Approximately 42.7% of MIH had T&S ordered, but only 2.9% received transfusions. Most patients who required a transfusion had a history of anemia. Significant cost savings could be incurred if routine T&S was eliminated prior to MIH.
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Affiliation(s)
- Anne Tjaden
- Loyola University Medical Center, Department of Obstetrics and Gynecology, Maywood, Illinois
| | | | - Linda C Yang
- Loyola University Medical Center, Department of Obstetrics and Gynecology, Maywood, Illinois
| | - Thythy Pham
- Loyola University Medical Center, Department of Obstetrics and Gynecology, Maywood, Illinois
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