ENVIRONMENTAL AND FINANCIAL BURDEN OF STAPLER VERSUS STAPLER-AVOIDING LAPAROSCOPIC APPENDECTOMY
Caitlin Lund*, Paul Pierson, Shiv Patel, David Kermode, Shankar Raman, Jan Franko
Mercy Medical Center, West Des Moines, IA
BACKGROUND: While financial efficacy is often emphasized, environmental impact of disposable medical devices for common procedures is often overlooked. We analyzed practice patterns of laparoscopic appendectomy and the cost and environmental burden of laparoscopic appendectomy depending on use of stapler versus stapler-avoiding operative technique.
METHODS: Consecutive series of all adult laparoscopic appendectomy at a 650-bed teaching hospital between January 2014 and October 2018 is analyzed. Consumption of selected disposable medical devices (clip applier, stapler and related loads, vessel sealer, Endoloop) was reviewed for cost and garbage weight (representing environmental burden). Stapler-based appendectomy was defined as use of any laparoscopic stapler, and non-stapler appendectomy was defined as no stapler used (exclusive use of clips, electrocautery, suture or vessel sealer). Fixed and nonoptional costs (drape, reusable laparoscopic instruments, medications, etc) were not considered.
RESULTS: There were 1650 adult laparoscopic appendectomy cases analyzed. 1569 (95.1%) used a stapler-based method, while 81 did not. More than one stapler handle was used in 130 cases (8.3%). 2.2±1.1 (median 2, range1-8) stapler reloads were used. Vessel sealers were used more frequently if a stapler was not used (3/81, 3.7% versus 15/1569, 0.9%; p=0.020). The average cost of disposable instruments was $148±283 in non-stapler cases as compared to $644±359 per stapler-based cases (p<0.001). Average weight of disposable instruments was 1351±585g per stapler-based case as compared to 30±117g in non-stapler cases (p<0.001). Operative time did not differ between the groups (46±37 versus 45±19 minutes; p=0.440)
CONCLUSION: Stapler-based laparoscopic appendectomy in our institution appears costlier and produces heavier environmental burden of disposable instruments as compared to appendectomy without stapler use.
Back to 2019 Posters
