Abstract
Background Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs)
provide equivalent flap survival and reduced operative time. 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.
Methods Economics were modeled for a single free tissue transfer (FTT) requiring one venous
anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis
using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique
were identified with an activity-based cost analysis. Price lists were retrieved from
suppliers to quantify disposable costs and capital expenditures. Two literature reviews
were executed to identify microsurgical operating room (OR) costs and operating time
reductions with coupler-assisted anastomoses.
Results For each venous anastomosis, the use of the anastomotic coupler increased disposable
costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable
OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes
with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings
of $234.89 were generated for each coupler-assisted anastomosis, recuperating the
device's capital expenditure after 13 uses.
Conclusion Compared with a hand-sewn venous anastomosis, an MACD produces savings with each
case and quickly recoups the device's capital expenditure. Despite its limitations
and simplicity, this study provides a practical economic analysis that can help inform
purchasing decisions, particularly for smaller volume centers where the economic rationale
may be less clear.
Keywords
microvascular anastomotic coupling device (MACD) - microsurgery - economics
