Diminishing Returns

Misplaced surgery sponges are dangerous, and more common than you might think

I came across an interesting article in Time magazine this last week.  Apparently a company has hit upon a way to better track the use of sponges in surgical procedures.  As you may know doctors use sponges (ranging from small gauze pads to cloth towels the size of dishrags) to soak up blood and other fluids in small and large body cavities.  I’m no surgeon, but I recall from my medical school surgery rotations the scrub nurse laying out dozens of used, bloodied rags on the ground so that she could keep close count of them.  At the beginning and end of each surgery the staff members are required to count the sponges to insure that none are left inside the patient after the incision is closed.  Apparently this is a relatively rare occurrence, but since hospital use hundreds of thousands of sponges each year even rare events can stack up.

There’s actually a medical term for this problem: gossypiboma (seriously—look it up).  The misplaced sponge problem occurs about 3,000 to 5,000 times yearly in the U.S.  This seems like a lot, but when you take into consideration that over 30 million major surgeries are done annually, retained sponges complicate surgeries in less than 2 one-hundredths of a percent of cases.  In other words, the surgical staff accurately accounts for the sponge number more than 99.98% of the time.

Now back to the article I read.  The company ClearCount has devised a way to insert a small electronic chip into each sponge and employ radio frequency technology to track sponges as they enter and exit the surgical field.  They claim they can dramatically improve the accuracy of sponge counts and decrease the rate of gossypiboma (they never actually used that term, but I like it so much I wanted to repeat it).

Currently the price tag for a couple packs of sponges is a drop in the bucket of the entire surgery bill.  This new technology, as you can imagine, would dramatically increase the amount paid out for an otherwise low-cost item—the sponges themselves are pricey, as are the devices that do the actually counting, at $15,000 a pop.  The upside is that they can prevent the nasty side effects that go along with unwanted surgical souvenirs.

Now don’t get me wrong.  I’m all for cutting the rate of medical mistakes and this sounds like a very reliable way to decrease a relatively rare but potentially disastrous problem.  My concern is with the with the cost-benefit ratio.

This whole issue reminds me of a doctor I knew while I was in residency.  He was a novice cyclist with a healthy reserve of disposable income who bought a high-end road bike for a few thousand dollars and began entering local road races.  After each race he took his bike back to the shop to have various stock parts—cranks, stem, forks—replaced by lighter, but much more expensive, titanium and carbon-fiber parts.  This seemingly lavish behavior is not uncommon in the biking world—as the weight of the bike drops, your speed (theoretically) improves, so you change out a $30 part for a $100 upgrade and shave a couple ounces off.  Ultimately you reach a point where it costs hundreds of dollars to subtract each additional gram of bicycle weight.  This is what they call the law of diminishing returns.

But while the value of this doctor’s bike rose to stratospheric levels his performance didn’t seem to budge much.  The problem didn’t lie in the weight of his titanium seat post but in the weight of his seat.  You see, he was carrying about 35 pounds of extra flab around his midsection—thousands of grams of excess weight that could come off for free if he were to simply eat less and ride more.

Worth the cost?

This is how I look at some health care costs.  The company ClearCount wants to sell us a system that potentially costs the economy a hundred million extra dollars year (for the sponges alone—this doesn’t take into account the equipment cost), with the promise that we can improve our rate of gossypiboma-free surgery from 99.98% to 99.99%.

If we lived in a world with unlimited resources I would be in favor of spending exponentially more for improvements that offer an exponentially smaller impact.  To the contrary, President Obama has correctly stated that tackling the spiraling costs of healthcare is our most important domestic challenge and that we need to make serious sacrifices in order to create a system of universal coverage.  So the question arises: What are the cheap, easy changes we can make that will have a big impact on healthcare costs and shouldn’t we address these before we start splurging on expensive technologies that offer only minimal incremental benefit?

I guess I shouldn’t single out ClearCount and their product as examples of medical dollars poorly spent—there are untold other areas where money should be redirected—but theirs seems like a pretty extreme example of diminishing returns in an environment where every single dollar is going to have to be counted as closely as sponges.