The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis
Background: Tobacco use significantly increases the rate of wound complications in patients undergoing total ankle arthroplasty (TAA). Preoperative optimization through smoking cessation programs significantly minimizes the rate of infection and improves wound healing in arthroplasty procedures. Des...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-03-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/24730114241239315 |
| _version_ | 1797255716742889472 |
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| author | Andrew H. Kim BS William ElNemer BS Miguel A. Cartagena-Reyes BS Majd Marrache MD John M. Thompson MD Amiethab A. Aiyer MD |
| author_facet | Andrew H. Kim BS William ElNemer BS Miguel A. Cartagena-Reyes BS Majd Marrache MD John M. Thompson MD Amiethab A. Aiyer MD |
| author_sort | Andrew H. Kim BS |
| collection | DOAJ |
| description | Background: Tobacco use significantly increases the rate of wound complications in patients undergoing total ankle arthroplasty (TAA). Preoperative optimization through smoking cessation programs significantly minimizes the rate of infection and improves wound healing in arthroplasty procedures. Despite its utility, minimal research has examined the cost-effectiveness of preoperative smoking cessation programs to reduce the need for extracapsular irrigation and debridement (I&D) due to wound complications following TAA. Methods: The cost of an I&D procedure was obtained from our institution’s purchasing records. Baseline wound complication rates among tobacco users who have undergone TAA and smoking cessation program cost were obtained from literature. A break-even economic analysis was performed to determine the absolute risk reduction (ARR) to economically justify the implementation of preoperative smoking cessation programs. Different smoking cessation program and I&D costs were tested to account for variations in each factor. ARR was then used to calculate the number needed to treat (NNT) to prevent a single I&D while remaining cost-effective. Results: Smoking cessation programs were determined to be economically justified if it prevents 1 I&D surgery out of 8 TAAs among tobacco users (ARR = 12.66%) in the early postoperative period (<30 days). ARR was the same at the literature high (27.3%) and weighted literature average (13.3%) complication rates when using the cost of I&D surgery at our institution ($1757.13) and the literature value for a smoking cessation program ($222.45). Cost-effectiveness was maintained with higher I&D surgery costs and lower costs of smoking cessation treatment. Conclusion: Our model’s input data suggest that the routine use of smoking cessation programs among tobacco users undergoing TAA is cost-effective for risk reduction of I&D surgery in the early postoperative period. This intervention was also found to be economically warranted with higher I&D costs and lower smoking cessation program costs than those found in the literature and at our institution. Level of Evidence: Level III, economic and decision analysis. |
| first_indexed | 2024-04-24T22:10:17Z |
| format | Article |
| id | doaj.art-4cc2c29e279944219494b71804830307 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-24T22:10:17Z |
| publishDate | 2024-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-4cc2c29e279944219494b718048303072024-03-20T10:03:19ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142024-03-01910.1177/24730114241239315The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even AnalysisAndrew H. Kim BS0William ElNemer BS1Miguel A. Cartagena-Reyes BS2Majd Marrache MD3John M. Thompson MD4Amiethab A. Aiyer MD5Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USADepartment of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USADepartment of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USADepartment of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USADepartment of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USADepartment of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USABackground: Tobacco use significantly increases the rate of wound complications in patients undergoing total ankle arthroplasty (TAA). Preoperative optimization through smoking cessation programs significantly minimizes the rate of infection and improves wound healing in arthroplasty procedures. Despite its utility, minimal research has examined the cost-effectiveness of preoperative smoking cessation programs to reduce the need for extracapsular irrigation and debridement (I&D) due to wound complications following TAA. Methods: The cost of an I&D procedure was obtained from our institution’s purchasing records. Baseline wound complication rates among tobacco users who have undergone TAA and smoking cessation program cost were obtained from literature. A break-even economic analysis was performed to determine the absolute risk reduction (ARR) to economically justify the implementation of preoperative smoking cessation programs. Different smoking cessation program and I&D costs were tested to account for variations in each factor. ARR was then used to calculate the number needed to treat (NNT) to prevent a single I&D while remaining cost-effective. Results: Smoking cessation programs were determined to be economically justified if it prevents 1 I&D surgery out of 8 TAAs among tobacco users (ARR = 12.66%) in the early postoperative period (<30 days). ARR was the same at the literature high (27.3%) and weighted literature average (13.3%) complication rates when using the cost of I&D surgery at our institution ($1757.13) and the literature value for a smoking cessation program ($222.45). Cost-effectiveness was maintained with higher I&D surgery costs and lower costs of smoking cessation treatment. Conclusion: Our model’s input data suggest that the routine use of smoking cessation programs among tobacco users undergoing TAA is cost-effective for risk reduction of I&D surgery in the early postoperative period. This intervention was also found to be economically warranted with higher I&D costs and lower smoking cessation program costs than those found in the literature and at our institution. Level of Evidence: Level III, economic and decision analysis.https://doi.org/10.1177/24730114241239315 |
| spellingShingle | Andrew H. Kim BS William ElNemer BS Miguel A. Cartagena-Reyes BS Majd Marrache MD John M. Thompson MD Amiethab A. Aiyer MD The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis Foot & Ankle Orthopaedics |
| title | The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis |
| title_full | The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis |
| title_fullStr | The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis |
| title_full_unstemmed | The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis |
| title_short | The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis |
| title_sort | cost effectiveness of smoking cessation programs for prevention of wound complications following total ankle arthroplasty a break even analysis |
| url | https://doi.org/10.1177/24730114241239315 |
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