Kevin L Grimes1, Charleen Scott2, Christopher R McHenry3. 1. Department of Surgery, MetroHealth Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH. Electronic address: kevin.grimes@gmail.com. 2. Department of Surgery, MetroHealth Medical Center, Cleveland, OH. 3. Department of Surgery, MetroHealth Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
Abstract
BACKGROUND: We performed 163 laparoscopic cholecystectomies at our institution during the third quarter of 2016. Direct supply cost per case varied from $524 to $1,022 among 14 surgeons. The purpose of this study was to determine the reasons for cost variation between high- and low-cost surgeons and identify opportunities for cost reduction. METHODS: Average cost of supplies per case was examined for laparoscopic cholecystectomy during a 6-month period. Two groups were created, with the 4 highest-cost surgeons comprising group A and the 2 lowest-cost surgeons comprising group B. The cost for each item was identified, and utilization was compared between groups. RESULTS: The average supply cost per case in group A was significantly greater than group B ($930 vs. $518). The difference persisted in subgroup analyses of both inpatients and patients with high American Society of Anesthesiologists scores. Compared with group A, surgeons in group B used reusable instruments more often and tended to choose lower-cost disposables. CONCLUSIONS: Significant variation in direct cost exists between surgeons performing laparoscopic cholecystectomy. Much of the cost difference can be accounted for by a relatively small number of high-cost instruments. We identified areas for cost savings by substituting lesser cost alternatives without compromising the quality of patient care.
BACKGROUND: We performed 163 laparoscopic cholecystectomies at our institution during the third quarter of 2016. Direct supply cost per case varied from $524 to $1,022 among 14 surgeons. The purpose of this study was to determine the reasons for cost variation between high- and low-cost surgeons and identify opportunities for cost reduction. METHODS: Average cost of supplies per case was examined for laparoscopic cholecystectomy during a 6-month period. Two groups were created, with the 4 highest-cost surgeons comprising group A and the 2 lowest-cost surgeons comprising group B. The cost for each item was identified, and utilization was compared between groups. RESULTS: The average supply cost per case in group A was significantly greater than group B ($930 vs. $518). The difference persisted in subgroup analyses of both inpatients and patients with high American Society of Anesthesiologists scores. Compared with group A, surgeons in group B used reusable instruments more often and tended to choose lower-cost disposables. CONCLUSIONS: Significant variation in direct cost exists between surgeons performing laparoscopic cholecystectomy. Much of the cost difference can be accounted for by a relatively small number of high-cost instruments. We identified areas for cost savings by substituting lesser cost alternatives without compromising the quality of patient care.
Authors: Christopher C Stahl; Shreyans Udani; Patrick B Schwartz; Taylor Aiken; Alexandra W Acher; James R Barrett; Jacob A Greenberg; Daniel E Abbott Journal: J Gastrointest Surg Date: 2020-10-09 Impact factor: 3.452