Cost minimisation analysis of change in closure technique of midline incisions.

OBJECTIVES: To make a cost minimisation analysis of incisional hernia repair at a county hospital and extrapolate the results nationally.
SETTING: County hospital, Sweden.
SUBJECTS: 861 patients who underwent midline laparotomy between August 1989 and November 1992.
INTERVENTIONS: In April 1991 surgeons were urged to change their suture technique towards wound closure with a suture length: wound length ratio of at least 4. MAIN OUTCOME MEASURES: Rate of incisional hernia at 12 months and the number of hernia repairs required with associated costs.
RESULTS: The average cost of one hernia repair was SEK 42643. After the intervention the risk of requiring a hernia repair was reduced by 0.016 for each patient operated on through a midline incision. The cost was reduced by SEK 686 and the cost of an operation 5 minutes longer was SEK 570, so the intervention generated savings of SEK 116 for each patient operated on. A similar reduction on a national level would yield annual savings of SEK 2107140, which may be regarded as the annual opportunity cost of an inadequate surgical technique in Sweden.
CONCLUSIONS: An alteration to the suture technique that reduces the rate of incisional hernia and the number of hernia repairs required is cost effective and generates savings.