B. R. Herring1, S. Jang1, Z. Aburjania1, H. Chen1 1University Of Alabama at Birmingham,Department Of Surgery, School Of Medicine,Birmingham, Alabama, USA
Introduction: Identifying provider variation in surgical costs could control rising healthcare expenditure and deliver cost-effective care. While these efforts have mostly focused on complex and expensive operations, provider-level variation in costs of thyroidectomy has not been well examined.
Methods: We retrospectively evaluated 989 consecutive total thyroidectomies performed by 14 surgeons at our institution between September 2011 and July 2016. Data were extracted from the McKesson Business Insight program. Total length of stay and cost were evaluated using the Mann-Whitney U and the Kruskal-Wallis tests. Categorical variables were evaluated with chi-square.
Results: Median patient age was 48 years (range 8-90), 81% were females, 64% were Caucasians, and 77% were outpatients. The number of thyroidectomies performed by the 14 surgeons ranged from 4 to 635 (mean = 71). The median costs per provider varied widely from $4,390.94 to $16,754.15 (P < 0.001). The mean length of stay was 1.2d ± 8.2 with wide variation among providers (0d to 5.5d). Providers whose hospital cost exceeded the institutional mean demonstrated a significantly higher ICU admission rate, anesthesia fees, and lab costs (P < 0.001).
Conclusion: We found substantial variation in hospital cost among providers for thyroidectomy despite practicing in the same academic institution, with some surgeons spending 4x more for the same operation. Implementing institutional standards of practice could reduce variation and the costs of surgical care.
