Variation in Intraoperative and Postoperative Utilization for 3 Common General Surgery Procedures.
Adult
Aged
Appendectomy
/ economics
California
Cholecystectomy, Laparoscopic
/ economics
Cost Control
Equipment and Supplies, Hospital
/ economics
Female
Herniorrhaphy
/ economics
Hospital Costs
Humans
Intraoperative Care
/ economics
Laparoscopy
/ economics
Length of Stay
/ economics
Male
Middle Aged
Operative Time
Postoperative Care
/ economics
Retrospective Studies
Surgical Procedures, Operative
/ economics
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
pubmed:
29
8
2019
medline:
11
8
2021
entrez:
29
8
2019
Statut:
ppublish
Résumé
The aim of this study was to understand variation in intraoperative and postoperative utilization for common general surgery procedures. Reducing surgical costs is paramount to the viability of hospitals. Retrospective analysis of electronic health record data for 7762 operations from 2 health systems. Adult patients undergoing laparoscopic cholecystectomy, appendectomy, and inguinal/femoral hernia repair between November 1, 2013 and November 30, 2017 were reviewed for 3 utilization measures: intraoperative disposable supply costs, procedure time, and postoperative length of stay (LOS). Crossed hierarchical regression models were fit to understand case-mixed adjusted variation in utilization across surgeons and locations and to rank surgeons. The number of surgeons performing each type of operation ranged from 20 to 63. The variation explained by surgeons ranged from 8.9% to 38.2% for supply costs, from 15.1% to 54.6% for procedure time, and from 1.3% to 7.0% for postoperative LOS. The variation explained by location ranged from 12.1% to 26.3% for supply costs, from 0.2% to 2.5% for procedure time, and from 0.0% to 31.8% for postoperative LOS. There was a positive correlation (ρ = 0.49, P = 0.03) between surgeons' higher supply costs and longer procedure times for hernia repair, but there was no correlation between other utilization measures for hernia repair and no correlation between any of the utilization measures for laparoscopic appendectomy or cholecystectomy. Surgeons are significant drivers of variation in surgical supply costs and procedure time, but much less so for postoperative LOS. Intraoperative and postoperative utilization profiles can be generated for individual surgeons and may be an important tool for reducing surgical costs.
Sections du résumé
OBJECTIVE
The aim of this study was to understand variation in intraoperative and postoperative utilization for common general surgery procedures.
SUMMARY BACKGROUND DATA
Reducing surgical costs is paramount to the viability of hospitals.
METHODS
Retrospective analysis of electronic health record data for 7762 operations from 2 health systems. Adult patients undergoing laparoscopic cholecystectomy, appendectomy, and inguinal/femoral hernia repair between November 1, 2013 and November 30, 2017 were reviewed for 3 utilization measures: intraoperative disposable supply costs, procedure time, and postoperative length of stay (LOS). Crossed hierarchical regression models were fit to understand case-mixed adjusted variation in utilization across surgeons and locations and to rank surgeons.
RESULTS
The number of surgeons performing each type of operation ranged from 20 to 63. The variation explained by surgeons ranged from 8.9% to 38.2% for supply costs, from 15.1% to 54.6% for procedure time, and from 1.3% to 7.0% for postoperative LOS. The variation explained by location ranged from 12.1% to 26.3% for supply costs, from 0.2% to 2.5% for procedure time, and from 0.0% to 31.8% for postoperative LOS. There was a positive correlation (ρ = 0.49, P = 0.03) between surgeons' higher supply costs and longer procedure times for hernia repair, but there was no correlation between other utilization measures for hernia repair and no correlation between any of the utilization measures for laparoscopic appendectomy or cholecystectomy.
CONCLUSIONS
Surgeons are significant drivers of variation in surgical supply costs and procedure time, but much less so for postoperative LOS. Intraoperative and postoperative utilization profiles can be generated for individual surgeons and may be an important tool for reducing surgical costs.
Identifiants
pubmed: 31460881
pii: 00000658-202107000-00021
doi: 10.1097/SLA.0000000000003571
pmc: PMC7035992
mid: NIHMS1047840
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
107-113Subventions
Organisme : AHRQ HHS
ID : F32 HS025079
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG021684
Pays : United States
Informations de copyright
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Nathan H, Dimick JB. Medicare's shift to mandatory alternative payment models: why surgeons should care. JAMA Surg 2017; 152:125–126.
Stey AM, Brook RH, Needleman J, et al. Hospital costs by cost center of inpatient hospitalization for medicare patients undergoing major abdominal surgery. J Am Coll Surg 2015; 220:207–217. e211.
Childers CP, Showen A, Nuckols T, et al. Interventions to reduce intraoperative costs: a systematic review. Ann Surg 2018; 268:48–57.
Adkins HH, Hardacker TJ, Ceppa EP. Examining variation in cost based on surgeon choices for elective laparoscopic cholecystectomy. Surg Endosc 2016; 30:2679–2684.
Benoit RM, Cohen JK. The relationship between quality and costs: factors that affect the hospital costs of radical prostatectomy. Prostate Cancer Prostatic Dis 2001; 4:213–216.
Brauer DG, Hawkins WG, Strasberg SM, et al. Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization. HPB (Oxford) 2015; 17:1113–1118.
Chung WC, Fan PL, Chiu HC, et al. Operating room cost for coronary artery bypass graft procedures: does experience or severity of illness matter? J Eval Clin Pract 2010; 16:1063–1070.
Kazberouk A, Sagy I, Novack V, et al. Understanding the extent and drivers of interphysician cost variation for spine procedures. Spine 2016; 41:1111–1117.
Meier JD, Duval M, Wilkes J, et al. Surgeon dependent variation in adenotonsillectomy costs in children. Otolaryngol Head Neck Surg 2014; 150:887–892.
Rosenbaum BP, Modic MT, Krishnaney AA. Value in single-level lumbar discectomy: surgical disposable item cost and relationship to patient-reported outcomes. Clin Spine Surg 2017; 30:E1227–E1232.
Sjogren PP, Gale C, Henrichsen J, et al. Variation in costs among surgeons and hospitals in Pediatric tympanostomy tube placement. Laryngoscope 2016; 126:1935–1939.
Thomas A, Alt J, Gale C, et al. Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction. Int Forum Allergy Rhinol 2016; 6:1069–1074.
Zygourakis CC, Valencia V, Boscardin C, et al. Predictors of variation in neurosurgical supply costs and outcomes across 4904 surgeries at a single institution. World Neurosurg 2016; 96:177–183.
Hofer IS, Gabel E, Pfeffer M, et al. A systematic approach to creation of a perioperative data warehouse. Anesth Analg 2016; 122:1880–1884.
Childers CP, Maggard-Gibbons M. Estimation of the acquisition and operating costs for robotic surgery. JAMA 2018; 320:835–836.
Sanders GD, Neumann PJ, Basu A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA 2016; 316:1093–1103.
Childers CP, Hofer IS, Cheng DS, et al. Evaluating surgeons on intraoperative disposable supply costs: details matter. J Gastrointest Surg 2018.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43:1130–1139.
Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg 2018; 153:e176233.
Yu YR, Abbas PI, Smith CM, et al. Time-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy. J Pediatr Surg 2016; 51:1962–1966.
Childers CP, Dworsky JQ, Russell MM, et al. Comparison of cost center-specific vs hospital-wide cost-to-charge ratios for operating room services at various hospital types. JAMA Surg 2019; 154:557–558.