Analysis of occupational exposures associated with emergency department thoracotomy

Background. Although previous studies have examined the cost effectiveness of emergency department thoracotomy (EDT),provider risk has not been included in these analyses. This study examined the costs associated with provider exposure to human immunodeficiency virus (HIV) and hepatitis from percutaneous injury during EDT. Methods: A decision tree describing the occupational risks and costs associated with EDT was created. Exposed providers undergo initial counseling, evaluation, and HIV postexposure prophylaxis and treatment as recommended by the Centers for Disease Control. Costs are reported from a health care system perspective in year-2000 dollars. The following prevalences were assumed: IRV (7.1%), hepatitis C (18%), and provider percutaneous injury rate (10%). Sensitivity analyses were performed by varying the prevalence of disease and the probability of seroconversion. Results: According to the authors' model assumptions, the probability is 0.00004 for HIV and 0.0027 for chronic hepatitis C seroconversion. The total additional cost per thoracotomy associated with an exposure is $1,377. Conclusions: Emergency department thoracotomy is associated with important provider medical risks. Future analyses of EDT should include these factors in reports on the value of this procedure.