A Cost-Savings Analysis of Skin Closure Devices: Incorporating Opportunity Cost into Operating Time Efficiency

Abstract

Introduction: The surgeon's armamentarium of skin closure techniques is abundant. This research aims to show the potential costs savings using 3M's Steri-Strip S (3S) when compared with sutures for skin closure. The current goal was to translate time savings into cost savings using 2 models: (1) the historical model is a strict analysis of variable (operating room [OR] time costs) and fixed (material) cost and (2) the true cost model estimates the opportunity cost available and adds this to the costs of the historical model. Materials and Methods: OR time costs per minute ($OR/min) were computed based on hospital estimates. Direct material costs were based on purchase prices of 4–0 PDS and 3S. Historical cost was computed from the equation OR procedure closure time × $OR/min + device costs. To assess opportunity cost, the potential time saved in an average surgeon's full OR day by using 3S instead of sutures was estimated. This available time was then revalued using the profit from an additional surgical procedure that could be performed in the time saved. Results: The hospital $OR/min is estimated to be $30. 4–0 PDS costs are $3.75 per suture, and 3S costs are $14.82 per device. The average breast reduction used 6 sutures or 16 3S devices for the final layer of skin closure. Similarly, the average abdominal case used 2 sutures and 14 3S devices. When using 3S instead of 4–0 PDS, time saved in the OR was noted to be 19.74 and 11.6 minutes per breast reduction and abdominal case, respectively. This resulted in historical cost savings of $377.58 and $148.02 per breast reduction and abdominal case, respectively. By using profit margin data from carpal tunnel release (a procedure that could be performed during the time saved), we estimated an opportunity cost of $97.30 per minute. By incorporating the opportunity cost, the true cost savings by using 3S instead of 4–0 PDS was $2298.28 and $1276.70 per bilateral breast reduction and abdominal case, respectively. Conclusion: Given that there is a significant time saving in using 3S over suture closure in approximating the skin, the authors conclude that 3S allows for greater efficiency in operating time use that leads to potential cost savings. Furthermore, although there appears to be cost savings in the historical model, there is a demonstration of greater cost savings if the opportunity cost is applied.