Bariatric Times

Spotlight on Technology December 2014

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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C4 Bariatric Times [DECEMBER 2014, SUPPLEMENT C] SPOTLIGHT ON TECHNOLOGY Refer to the Instructions for Use for a complete description of all warnings, precautions, and contraindications. Products listed may not be available in all markets. ECHELON FLEX™ and ENDOPATH® are trademarks of Ethicon. PERI-STRIPS DRY® is a trademark of Synovis Surgical Innovations, a division of Synovis LIfe Technologies, Inc. GORE®, BIO-A®, SEAMGUARD®, and designs are trademarks of W. L. Gore & Associates. © 2014 W. L. Gore & Associates, Inc. Gore products referenced within, if any, are used within their FDA approved/cleared indications. Gore does not have knowledge of the indications and FDA approval/clearance status of non-Gore products. Gore makes no representations as to the surgical techniques, medical conditions or other factors that may be described in the article(s). The reader is advised to contact the manufacturer for current and accurate information. AT1985-EN1 b eyond the particular cost for a specific product and look instead at the cost of caring for that patient when that product is used compared to when that product is not used. Once we make those comparisons, we can more fairly judge whether that product itself is "worth" the amount that it costs as it pertains to the total cost o f care for the patient. How do you communicate that the "cost of preventing complications" is less than the "cost of treating plus legal costs"? A: If we look at staple line reinforcement materials such as GORE ® SEAMGUARD ® Reinforcement, there's no question that the cost of that material itself is far less than the cost of treating a potential leak, which could run into the hundreds of thousands of dollars (e.g., reoperation to endoscopy and stent placement, to conversion to another surgical procedure). Legal costs are both an issue for the institution and for the surgeon. For instance, a surgeon who chooses to not use reinforcement material in a sleeve gastrectomy procedure, and then has a complication, which could have been potentially been prevented by the use of that material, could face fairly significant legal costs, especially in light of recent literature supporting the use of staple line reinforcement material. in sleeve gastrectomy. 1 I believe that in those instances there is no question that the cost incurred from purchasing product is far less than the potential costs to the patient, surgeon, and instituition, that may result from a complication. What is the potential cost of a complication? A: It doesn't take long before complications mount in potential costs to both the hospital and to the patient or the patient's insurance carrier. Treating a complication might include a blood transfusion, clip appliers, endoscopy, and stenting, all of which cost money. For instance, the cost of a stent, which might be placed in the event of a leak, is around $2,000. Other expenses to consider include reoperations, operating room time, equipment, anesthesia, and the cost of a hospital stay, which is approximately $400 to $500 at our hospital. A stay in the intensive care unit (ICU) is around $1,000 per day. Any cost spent on measures we can take to prevent complications, whether it be using GORE ® SEAMGUARD ® Staple Line Reinforcement or GORE ® BIO-A ® Tissue Reinforcement material to close the potential space for an internal hernia, either transmesenteric or retro Roux limb, is fairly small compared to the potential cost to that patient of additional hospitalization, reoperation, or something ultimately that would lead to bowel death and the need for multiple reoperations. How do you handle a surgeon's objections to using GORE ® SEAMGUARD ® Reinforcement because it adds additional costs to a case? A: I encourage the surgeon to be proactive from the standpoint o f patient safety and quality of outcomes. Hospitals are now being driven by patient safety standards, safe surgery, quality outcomes, and patient satisfaction, and all of those things are potentially impacted by the patient's hospital experience. I believe surgeons should consider approaching the hospital administration or their purchasing department and discuss the value of incorporating a product that has been shown to reduce complications in bariatric and metabolic surgery. Reduction in complications means improving quality and outcomes. I think that approach will be successful in getting the administration to understand that the cost up front for the product is worth it in the long run. How should hospital administrators address reducing complications and managing costs? A: As administrators, we have to look at both short-term and long-term costs of anything we do. It's important to be focused on the return on investment (ROI) on anything that we do. So, if we look at a new piece of equipment or technology we want to know what the ROI is for it. If we look at the use of something that may prevent complications, we consider the investment in that particular patient population. For instance, the investment in the use of GORE ® SEAMGUARD ® Reinforcement in a patient having a sleeve gastrostomy, the ROI is reducing the potential complications, leading to a safe, quality surgical outcome. This means reducing the long-term cost for the hospital since expenses can mount with a complication. References 1. Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10(4):713–723. View videos from the authors' surgical cases online at http://spotlight.metabolicsurgery.tv s

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