Nilesh Mahajan

Abstract

Background: The incidence of surgical site infections is higher in India compared to the rest of the world. In orthopedic surgeries, the risk is even higher. Surgical site infections following orthopedics are associated with an additional length of stay resulting in additional costs thus causing a significant economic burden on patients and society.We aimed to determine the additional costs and length of stay and evaluate the efficacy of triclosan-coated sutures in reducing surgical site infections rate. Materials and Methods: A systematic literature search of available evidence for both epidemiologic and economic data pertaining to the incidence of surgical site infections and efficacy of triclosan-coated sutures, from 1998-2018 and 2000-2018 respectively, were gathered. We compared 100 surgeries from private and public hospitals from orthopedics and calculated cost-effectiveness of triclosan-coated sutures in comparison to conventional non-coated sutures using a decision-tree cost model. Results: Two studies were analysed for analysis of surgical site infections’ incidence and for the efficacy of triclosan-coated sutures vs non-coated sutures, 3 studies were included.We performed a one-way sensitivity analysis to calculate the impact of % efficacy and surgical site infections’ incidences %, cost of noncoated and triclosan-coated sutures on cost savings depicted by Tornado charts. Sensitivity analysis on the comparison of triclosan-coated sutures with non-coated sutures, a base cost saving of orthopedic surgeries for a private hospital was is INR -5573 and public hospital INR -1410. Conclusion: The use of triclosan-coated sutures reduced surgical site infections incidence and cost savings for orthopedic surgeries in both public and private sectors in India. Keywords: Orthopedic, Non-coated suture, Surgical site infection, Triclosan-coated suture.

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Abstract

Objectives: The present study demonstrates the efficacy and economic outcome of triclosan-coated sutures (TCS) Vs conventional non-antimicrobial-coated sutures (NCS) for surgical site infections (SSIs) in obstetrics and gynecology (Ob/Gyn) in India. Materials and Methods: A systematic literature search of available evidence for both SSI incidences and TCS efficacy data in India from 1998-2018 and 2000-2018, respectively, were gathered. We collected cost data from a private and public hospital, respectively for both Laparoscopic hysterectomy (L-hysterectomy) and Cesarean-section (C-section). Cost-effectiveness of TCS in comparison to the conventional NCS was calculated using a decision-tree deterministic model. Results: We performed one-way sensitivity analysis to compare TCS with NCS. We found a base cost - saving for C-section at private hospital, INR 5513 and public hospital INR 791 whereas for L-hysterectomy it was INR 4924 at private hospital and INR 999 at public hospital. For C-section, at private hospital, the cost-saving for SSIs per 100 surgeries at SSI incidence rates (3.77%, 7.94%, and 24.2% at low efficacy (41%) (INR 2,05,508, INR 4,41,668, and INR 13,62,526, ) and high efficacy (61%) were (INR 3,09,657, INR 6,61,018, and INR 20,31,075). For L-hysterectomy, at private hospital, the cost- saving for SSIs per 100 surgeries for SSI incidence rates (2.28%, 6.51%, and 11.7%) at low efficacy (41%) were (INR 1,32,902; INR 3,94,313; and INR 7,15,052, and high efficacy (61%) were (INR 2,01,635; INR 5,90,564; and INR 10,67,760). Conclusion: Decision tree modeling showed that the use of TCS resulted in cost savings for Ob/Gyn surgeries in India. Keywords: Cost savings, Nonantimicrobialcoated sutures, Obstetrics and gynecology, Surgical site infection, Triclosancoated sutures

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