M. E. Mallah1, M. Barringer2, M. E. Thomason1, E. Ross3, B. Matthews1, C. E. Reinke1 3Carolinas Healthcare System,Cost Analytics,Charlotte, NC, USA 1Carolinas Medical Center,Department Of Surgery,Charlotte, NC, USA 2Carolinas Medical Center-Cleveland,Shelby, NC, USA
Introduction: Supply cost variation for surgical procedures is poorly described in the literature. Prior studies have demonstrated that implementation of a standardized preference card was able to reduce costs. Our aim was to describe variation in supply cost across a cohort of surgeons within a large healthcare system.
Methods: Cost of operative supplies is prospectively recorded for all cases. Total operating room supply cost was calculated for all laparoscopic appendectomy and laparoscopic cholecystectomy cases performed between January 2016 and June 2017. Other variable and fixed operating room costs were not included. The primary surgeon was identified for each case and the number of cases and mean cost per case was calculated per surgeon. Surgeons who had performed less than 5 cases in either category during the 18-month period were excluded from that analysis.
Results:Across 8 facilities in our healthcare system 3,250 cholecystectomies and 1,678 appendectomies were performed by 79 surgeons over an 18-month period. Low volume surgeons were excluded (16 for cholecystectomy, 18 for appendectomy). Mean OR supply cost was $528 for a cholecystectomy (mean cost/surgeon ranged from $303-1091) and $885 for an appendectomy (mean cost/surgeon range $585-1374). There was significant variation by surgeon, with the mean cost/case for the most expensive surgeon being more than three times more expensive than the lowest cost surgeon for a cholecystectomy and almost more than 2 times as much for a cholecystectomy. Surgeon volume was not significantly correlated with mean cost (Figure 1, p>0.05 for both). Increased OR supply cost was significantly associated with increased OR time for cholecystectomies (p<0.01) but not for appendectomies (p=0.44).
Conclusion:We identified wide variation in mean supply cost per case for laparoscopic appendectomies and laparoscopic cholecystectomies across a large healthcare system. Higher cost cases were associated with longer operative time for cholecystectomies but not appendectomies. Future studies to assess methods to decrease variation and the effect of operating room supply cost on patient outcomes are needed.
