Procedure costs associated with the use of Harmonic devices compared to conventional techniques in various surgeries: a systematic review and meta-analysis

Abstract

BackgroundAs compared to conventional techniques, recent meta-analyses have reported cost savings with Harmonic devices; however, only in thyroidectomy. Thus, the aim of this study was to evaluate the costs associated with Harmonic devices versus conventional techniques across a range of surgical procedures.MethodsA systematic search of MEDLINE, EMBASE, and Cochrane Library was conducted from inception to October 01, 2016 without language restrictions to identify randomized controlled trials comparing Harmonic devices to conventional techniques and reporting procedure costs (operating time plus operating equipment/consumables/device costs). Costs were pooled using the ratio of geometric means, and a random effects model was applied. Sensitivity analyses varying statistical methods, number of included studies, and cost outcomes were completed to test the robustness of the results.ResultsThirteen studies met the inclusion criteria. A total of 561 and 540 participants had procedures performed with Harmonic devices and conventional methods, respectively, with procedures including gastrectomy, thyroidectomy, colectomy, cholecystectomy, Nissen fundoplication, and pancreaticoduodenectomy. As compared to conventional methods, Harmonic devices reduced total procedure costs by 8.7% (p=0.029), resulting in an absolute reduction of US$227.77 from mean conventional technique costs, derived primarily from a reduction in operating time costs. When operating time costs, excluding operating equipment/consumables/device costs, were analyzed, costs were reduced by $544 per procedure with the use of Harmonic devices. The results from all sensitivity analyses demonstrated cost reductions with Harmonic devices.ConclusionThis systematic review and meta-analysis showed that despite a higher device cost, Harmonic devices provide a statistically significant reduction in procedure costs, derived primarily from a reduction in operating time costs, across surgical procedures. In addition to functionality benefits, Harmonic devices may represent a potentially cost saving method to reduce overall hospital resource use. Future research should focus on potential costs and benefits from use of Harmonic devices in procedures not covered here.

Total thyroidectomy: conventional suture ligation technique versus sutureless techniques

“…23,38 One of the disadvantages of the use of Harmonic FOCUS® is the high expense of the device but it can be reused, furtherly this should be weighed with the reduction of the operative time, operating team time, operating room occupancy with more surgeries can be performed in the same operative session with better utilization of health resources and reduction of the waiting list, reduction of the anesthesia costs, pain medication, nursing time, morbidity treatment, redo surgeries, hospital stay, and eliminates the cost of sutures, accordingly decreasing the overall hospital costs which are evident with the use of Harmonic FOCUS®. 8,12,39,40 In our study the Harmonic FOCUS® group had significantly shorter hospital stay, p=0.002, which was due to the reduction in overall complications in this group, a similar result to that got by others. 8,14 The pitfall of a shortened length of hospital stay in the HS group was that there was a possibility of overlooking cases of symptomatic hypocalcaemia which may develop within 48 hours postthyroidectomy.…”

A device category economic model of electrosurgery technologies across procedure types: a U.S. hospital budget impact analysis

“…This appears to be the first published study to assess the hospital budget impact of adopting an entire category of devices in the electrosurgical space. Moreover, this study used differences in resource use outcomes to model economic impact, demonstrating that improved hospital outcomes can lead to lower hospital costs, as is consistent with other literature 18,55,56 . Further, this category-wide approach may be more informative than traditional line-by-line item comparisons.…”

“…Ultrasonic devices are a type of advanced energy device that convert electrical energy to mechanical vibration, allowing simultaneous hemostasis and tissue transection 2,18 . Advanced bipolar devices use radiofrequency energy to achieve coagulation and hemostasis, but require an additional mechanical integrated knife blade for tissue transection 2,5,7,[15][16][17] .…”

“…Advanced bipolar devices use radiofrequency energy to achieve coagulation and hemostasis, but require an additional mechanical integrated knife blade for tissue transection 2,5,7,[15][16][17] . There are numerous devices within these device categories that are tailored to specific specialties, procedures and vessel sizes 2,5,[7][8][9]18,19 . Published meta-analyses have shown the value of ultrasonic energy devices in terms of OR time savings and reductions in blood loss and related complications compared with conventional methods [10][11][12] , with additional clinical studies showing trends toward improvements compared with other advanced energy devices [7][8][9]19,20 .…”

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

“…It is crucial to educate the operation theater staff, improve preoperative planning, and employ efficient surgical methods to decrease the effect of operative time on surgical outcomes [23]. Furthermore, a systematic review and meta-analysis by Cheng H et al showed that a reduction in operative time can significantly reduce the overall costs of the surgical procedure [24]. Thus, both time-and cost-effectiveness are crucial for the clinician while making surgical decisions [20].…”