PRACTICAL AND THEORETICAL ASPECTS OF THE COST-BENEFIT RATIO IN VISCEROSYNTHESIS

The necessity of limiting health care costs requires adequate service recording and quality control even in visceral surgery. In this field, the safety of the anastomoses is of greatest importance. anastomoses at risk are esophageal connections to jejunum or colon and deep rectal anastomoses. At these locations expensive suture devices, such as sta pling instruments, can be used in a cost saving aspect, if they help t o increase anastomotic safety, time saving and expansion of surgical i ndication. Manual sutures thus represent the cheapest anastomotic tech nique as continuous sutures would cost between DM 10.- to 20.- and sin gle stitch sutures between DM 60.- and 100.-. A surgical school should prevalently aim at training manual anastomoses, while special anastom otic techniques should only complete the skill for selected indication s. The overall staff expenditure for extended operations amounts aroun d DM 600.- per hour respectively DM 10.- per minute. Time for surgery might be shortened by auxiliary tools as much as to perform an additio nal operation. However, a circular stapler anastomosis that costs betw een DM 650.- to 850.- is twice as expensive as manual sutures notwiths tanding the double time needed. In the past years, the necessity for a rational use of different anastomotic techniques has shown to be mand atory since, increasingly, financial aspects of health economy require cost benefit calculations in visceral surgery.