Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses

PURPOSE: Surgical outcomes associated with the use of microvascular anastomotic coupling devices (MACD) are well reported in the literature – compared with hand-sewn anastomoses, MACDs provide equivalent flap survival^1,2 and reduced operative time.^3,4 To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis.

MATERIALS AND METHODS: Economics were modeled for a single free tissue transfer requiring one venous anastomosis performed with either hand-sewn sutures or with the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance Incorporated; Birmingham, Alabama). Activity-based cost analysis was performed to identify all fixed and variable costs incurred with the use of the coupler device – relevant economic variables included: (i) disposable costs (e.g. coupler ring, suture), (ii) capital expenditure of the coupler device, and (iii) fixed and variable operating room (OR) costs (e.g. overhead, labor). Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. The reported reduction in operative time with coupler-assisted anastomoses and the reported microsurgical OR costs were determined through comprehensive literature reviews. Historically reported costs were converted to present day values using the United States Medical Care Inflation Rate. The total net savings per use and the number of uses required to offset the coupler device’s capital expenditure (payback) were calculated.

RESULTS: Compared with hand-sewn sutures, use of a MACD increased disposable costs by $284.40 for each venous anastomosis (cost of coupler ring less cost of unused suture). The inflation-adjusted variable and fixed costs of OR time (includes labor, supplies, overhead; excludes physicians fees) was $30.82 per minute. Coupler-assisted anastomosis reduced operating time by a mean of 16.9 minutes, which decreased OR costs by $519.29. The total savings for each coupler-assisted anastomosis was $234.89 – savings generated from each anastomosis payback the device’s capital expenditure after 13 uses.

CONCLUSIONS: Compared with hand-sewn venous anastomosis, a MACD produces savings with each case and quickly recoups the device’s capital expenditure – if the MACD is used greater than 13 times over its lifespan, the device provides economic benefit to the institution.