OBJECTIVES: Electrocardiograph (ECG) systems used during and after coronary artery bypass graft (CABG) surgery can be reusable (rECG) or single-patient-use (spECG). Standard of care rECG has been shown to be contaminated in 33-77% of cases, increasing the surgical site infection (SSI) risk. SSIs are an NHS England care quality indicator. Avoidable SSIs within 30 days of CABG are not reimbursed. As spECG can significantly reduce SSI post-CABG, how would full transition to spECG impact NHS budgets?

METHODS: A 1-year Markov model was informed by published literature and patient data from Hospital Episode Statistics 2016-2017: mean characteristics of age 67.5 years, 19% female, and 28% obese. Health states included CABG, mechanical ventilation, intensive care unit (ICU), general ward, SSI, deep-sternal wound infection (DSWI), outpatient, and deceased. In-hospital, ECG monitoring was used for ≤4 days. By day 11 post-CABG, 2.15% of rECG and 1.60% of spECG patients would develop an SSI. SSI and DSWI increased length of stay (LOS) by 11 and 23 days, respectively. Outpatient SSI resulted in readmission or outpatient care. Costs and payments (2017 GBP) from NHS tariffs and published literature.

RESULTS: The mean annual cost of care was £7,352 per patient with rECG and reduced by £73 (1%) with use of spECG. Cost reduction was driven by reduced SSI resulting in shorter LOS. With a reduction of 3.7 ICU days and 1.5 readmissions per 100 CABG patients. Fewer readmissions reduced hospital revenue by mean £35 per patient, but overall spECG increased hospital profits: +£38 per patient. Following 2,000 simulations, results showed significance at p<0.05. The median saving was $16,514 (95% credible interval $5,200 to $48,326).

CONCLUSIONS: Driven by lower SSI incidence, use of spECG systems in the NHS are expected to result in reduced revenue and costs and increased profit for hospitals