Economic Benefits of SPY

Cost Savings in CABG

The use of SPY during CABG and other surgeries has been proven in several independent studies to improve procedural quality and outcomes which results in cost savings for hospitals. In early 2009, Bruce Ferguson, MD, of the East Carolina Heart Institute, reported results from the SPY VICTORIA™ Cardiac Surgery Registry. Dr. Ferguson concluded that in the nearly 300 patients, the reduction in the incidence of major adverse events in patients treated with SPY can result in significant cost savings for hospitals.

In the FY 2010 Final IPPS Rules, the Centers for Medicare and Medicaid Services (CMS) published a report confirming that the use of SPY during CABG reduced hospital costs by improving outcomes. CMS reported that they had examined data on CABG surgery cases with SPY in the FY 2008 MedPAR file. CMS confirmed that CABG cases utilizing SPY across all 4 CABG MS-DRGs, had a shorter length of stay and lower average costs compared to all cases in which SPY was not utilized. Cases reported involving SPY consistently resulted in cost reductions averaging $1973-$4628 depending on MS-DRG.

Sentara Heart Hospital in Norfolk, VA is ranked number 26 among the top 50 ranking heart hospitals in the United States according to U.S. News & World Report magazine. Sentara introduced the SPY Imaging System to its cardiac surgery program in January 2008. Sentara performs approximately 1400 CABG procedures annually and uses SPY before and after coronary bypass. Sentara recently examined the impact of SPY on costs in 358 CABG procedures compared to 225 procedures performed without SPY. Use of SPY in 61% of CABG procedures at Sentara resulted in an overall >3% decrease in fully allocated resource costs, and costs for CABG with SPY were 4.22% lower versus those without SPY in a case mixed analysis.

Similarly, Cookeville Regional Medical Center in Tennessee performed a business case study to assess the impact of SPY on the cost of care at their facility. Cookeville performs more than 300 CABG procedures each year and is already considered a "low cost" facility, because its Medicare reported costs are below national averages. Results of the study, which compared costs in patients undergoing CABG including SPY to those without SPY, demonstrated a significant reduction in length of stay and average total charges for patients undergoing CABG including SPY. Cost reductions were attributed to reductions in pharmacy charges, ICU charges and overall length of hospital stays.  

In response to the results of the study, Cookeville Hospital Administrator Bill Little commented, "Reductions in length of stay, pharmacy and ICU costs represent real improvements to our bottom line. The SPY system has paid for itself."

Cost Savings in Plastic Reconstructive Surgery

Complications occuring following plastic reconstructive surgeries such as breast and facial reconstruction can be physically and emotionally devastating to patients and extremely costly for hospitals. Recent reports have shown that in an average hospital perfoming 150 immediate breast reconstructions per year, the annual direct cost of managing post-operative infection following implant placement, mastectomy flap failure and DIEP flap anastomotic failure alone, can be as much as $426,000 or an average of $2845 per case. Most of these costs can be attributed to prolonged ICU days, returns to surgery and hospital stays that on average can increase by as many as four or more days. If complications occur during the global period for the original surgery, reimbursement can be limited.

Dr. Geoffrey C. Gurtner, the Director of Breast and Aesthetic Surgery at Stanford University Hospital recently wrote, "If the use of SPY reduced the rate of post-operative infections by a conservative estimate of 50% and decreased the other complications by 90%, it would result in direct cost savings of $2140 per patient undergoing immediate breast reconstruction."

The majority of complications in reconstructive surgery, such as tissue necrosis, non-healing wounds and flap failure, can be traced back to failed or poor perfusion at either the micro or macro circulatory level. For example, in free flap surgeries, tissue is harvested from one area of the body and then reattached in another area via blood vessels that are microsurgically co-joined to other vessels. These vessles can become inadvertantly kinked or clotted and therefore, unable to supply adequate blood to the transferred tissue. Unfortunately, poorly functioning vessels or poorly perfused tissue may not be clinically apparent at the time of the primary surgery. The problem typically becomes evident in the post-operative period and usually results in a return to surgery and additional days in the ICU.

Dr. Michael Zenn, a Plastic Surgeon at Duke University Medical Center commented, "SPY imaging equips the surgeons with an angiographic method of directly evaluating the quality of blood flow in co-joined vessels and tissue perfusion in real-time and during the primary surgery. SPY can empower the surgeon to make evidence-based decisions that can reduce the potential for these types of costly complications."

In the conclusion of his paper, Dr. Gurtner said, "We believe that SPY is a safe and easy tool to definitively determine perfusion at both the small and large vessel level. It has proven useful in determining tissue viability and providing angiogram-like maps of large vessels and perforators. In our experience, this has led to decreased complications for patients undergoing immediate breast reconstruction with improved cosmetic outcomes and significant savings in surgeon time and health care resources."