A Cost-Utility Analysis Comparing the Sartorius versus the Rectus Femoris Flap in the Treatment of the Infected Vascular Groin Graft Wound

Chatterjee, Abhishek; Kosowski, Tomasz; Pyfer, Bryan J.; Fisher, Carla S.; Tchou, Julia; Maddali, Sirish

doi:10.1097/prs.0000000000001267

Cited by 17 publications

(10 citation statements)

References 19 publications

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“…21,[24][25][26][27][28] The end states of sartorius flap reconstruction, excision of graft and axillaryfemoral bypass, amputation, and death were obtained from our groups' previously published work. 29…”

Section: Decision Model and Probabilitiesmentioning

confidence: 99%

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

Bloom

Tian

Homsy

et al. 2022

The American Surgeon™

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Objective Closed-incision negative pressure therapy (CINPT) with the Prevena system has been used and clinically evaluated in high-risk groin incisions to reduce the risk of postoperative complications. We performed a cost-effectiveness analysis evaluating CINPT in femoral-popliteal bypass with prosthetic graft. Methods A literature review looking at prospective randomized trials determined the probabilities and outcomes for femoral-popliteal bypass with and without CINPT. Reported utility scores were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure and postoperative complications. Medicare current procedure terminology and diagnosis-related group codes were used to assess the costs for a successful surgery and associated complications. A decision analysis tree was constructed with rollback analysis to highlight the more cost-effective strategy. An incremental cost-effectiveness ratio (ICER) analysis was performed with a willingness to pay at $50,000. Deterministic and probabilistic sensitivity analyses were performed to validate the robustness of the results, and to accommodate for the uncertainty in the literature. Results Femoral-popliteal bypass with CINPT is less costly ($40,138 vs $41,774) and more effective (6.14 vs 6.13) compared to without CINPT. This resulted in a negative ICER of −234,764.03, which favored CINPT, indicating a dominant strategy. In one-way sensitivity analysis, surgery without CINPT was more cost-effective if the probability of successful surgery falls below 84.9% or if the cost of CINPT exceeds $3139. Monte Carlo analysis showed a confidence of 99.07% that CINPT is more cost-effective. Conclusions Despite the added device cost of CINPT, it is cost-effective in vascular surgical operations using groin incisions.

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Section: Decision Model and Probabilitiesmentioning

confidence: 99%

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

Bloom

Tian

Homsy

et al. 2022

The American Surgeon™

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“…1,12,17,28 Chatterjee A et al reported that the rectus femoris muscle flap is more cost effective when used to treat the infected vascular groin graft wound. 29 Ryu DY et al mentioned that Sartorius muscle flap lacks bulk and has a limited arc rotation, making it suboptimal for large wounds, in comparison to rectus femoris muscle flap, but the rectus femoris muscle flap needs a longer separate incision in the thigh. 16 They stated also that due to the segmental blood supply arising from superficial femoral artery, some vascular surgeons might hesitate to use the Sartorius muscle flap in patients with an occluded superficial femoral artery.…”

Section: Discussionmentioning

confidence: 99%

Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

et al. 2017

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Background: Groin vascular infections are potentially catastrophic situations as limb loss or even death may occur in a high percentage of patients. A growing evidence support the benefit of muscle flap covering for these non-healing or infected wounds with stressing on their increased efficacy when used prophylactically. Sartorius muscle flap is granted here by its anatomical characteristics.Methods: Fifty Sartorius muscle flaps were done for 39 patients. Flaps were done routinely on prophylactic basis for protection of native femoral vessels or vascular grafts either for oncological or vascular causes in conjunction with inguinal lymphadenectomy or femoral bypass graft. Great care was taken to preserve the first segmental branch to the muscle and avoided its injury.Results: Prophylactic Sartorius muscle flap was done for oncological causes in 46% while for vascular causes in 54% of total flap number. The operative time ranged from 14-20 minutes for every flap with mean 16 minutes with negligible blood loss and no any donor site morbidity. The complication rate was 26%, including mild skin infection 12%, seroma 6%, partial superficial skin necrosis 6%, and hematoma 2%.Conclusions: Sartorius muscle flap has versatile benefits. Its role has been proved as a shield protecting and covering the femoral vessels or vascular grafts and resulted in decreased rate of overall complications. We recommend prophylactic Sartorius muscle flap coverage on routine basis considering it the workhorse of efforts done to vascular protection.

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“…Interestingly, in comparing costs, the RFF appears to be a cost-effective choice for coverage of complex groin wounds. In a series of 296 patients undergoing 62 RFFs and 234 sartorius flaps, Chatterjee et al 20 reported a 14% major complication rate (defined as graft excision, amputation, or death) with sartorius flaps and only a 9% major complication rate for RFFs. Based on a oneway sensitivity analysis, these investigators determined that sartorius flaps would become cost-effective only if their major complication rate fell below 9%.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 99%

Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions

Ryer

Garvin

Kapadia

et al. 2020

Journal of Vascular Surgery

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A Cost-Utility Analysis Comparing the Sartorius versus the Rectus Femoris Flap in the Treatment of the Infected Vascular Groin Graft Wound

Abstract: The rectus femoris flap in the treatment of the infected vascular groin graft is a cost-effective option compared with the sartorius flap.

Cited by 17 publications

References 19 publications

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions

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