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188 - 05-25
Surgeon Variation in the Cost of Laparoscopic Nephrectomy

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Surgeon Variation in the Cost of Laparoscopic Nephrectomy

Lindsay A. Hampson, Anobel Y Odisho, Maxwell V Meng, Peter R Carroll

Introduction

Identifying surgical procedures with significant variation in surgical costs may identify opportunities for cost-effectiveness, standardization, and quality improvement

We chose to evaluate laparoscopic nephrectomy (LapNx) given that this is a common urologic procedure which is high-volume and  fairly easy to standardize.

OBJECTIVE: Identify surgical cost variation through evaluating OR supply cost-level utilization data by surgeon

Methods

•All LapNx performed at UCSF over 1 year period (9/2012 – 9/2013)
•62 procedures performed by 5 urologists (surgeon case range 2-28)
•Surgeons de-identified
•Costs
•Supplies: institutional-negotiated rate, reflecting amount paid by UCSF for each item (NOT reimbursement)
•Operative time monetized assuming $69/minute
•Analysis
•One-way ANOVA and pairwise t-tests for comparison
•Univariate and multivariate analysis of factors associated with case supply cost above the mean was conducted using multilevel mixed effects logistic regression grouped by surgeon
 
Results

In univariate and multivariate analysis evaluating years of experience, case-specific surgical volume, or case start after 3 pm, there were no significant associations with a surgeon’s mean supply cost being above the overall mean cost (p > 0.05)

Discussion

Potential Interventions

•Surgeon feedback: surgeons could receive their own data in comparison to their anonymized peers for self-evaluation
•Standardize surgical technique: variation may lead to disparate outcomes, decreased efficiency, & increased costs
•Procedural standardization: may improve patient outcomes
•Increase OR efficiency: standardization may lead to faster and more accurate set-up and turnover
•Decrease cost: shift to lower cost items of equal efficacy and re-evaluating use of expensive items

Benefits of Approach

•Reflects real-world materials usage & actual cost-level data
•Deeper understanding of variation in approach/technique
•Facilitates open discussion of reasoning/justification of different approaches, material usage

Limitations

•Cost not linked to patient’s diagnosis or outcome data
•Cost data does not reflect cost of overall hospital stay

Future Directions

•Incorporate predisposing factors, outcomes, & complications
•Re-evaluate data after surgeon feedback to look for change
 
Concusions

Analysis of OR supply utilization shows significant variation in both supply and time costs by surgeon which are not accounted for by surgeon experience or volume.

These data must now be reconciled with patient diagnosis and outcomes to identify how we can provide high value, efficient care while maintaining excellent patient outcomes