Vigneswaran Yalini, Linn John G, Gitelis Matthew, Muldoon Joseph P, Lapin Brittany, Denham Woody, Talamonti Mark, Ujiki Michael B
Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago, Chicago, IL.
Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston, IL.
J Am Coll Surg. 2015 Jun;220(6):1107-12. doi: 10.1016/j.jamcollsurg.2015.02.030. Epub 2015 Mar 14.
Our aim was to determine the impact of surgeon education regarding disposable supply costs to reduce intraoperative costs for a common procedure such as inguinal hernia repair.
At the end of the 2013 fiscal year (FY 13), surgeons in our department were provided with information about the cost of disposable equipment and implants used in common general surgery operations. Surgeons who historically had lower supply costs demonstrated individual techniques to their colleagues. No financial incentive or punitive measures were used to encourage behavior change. Surgical supply costs for laparoscopic and open inguinal hernia repair in FY13 were then compared with costs during fiscal year 2014 (FY14) using Mann-Whitney U tests.
The average cost of laparoscopic inguinal hernia repairs decreased from an average $1,088±473 (±SD) in FY13 (n=258) to $860±441 (n=274) in FY14 after surgeon education, representing a 21.0% reduction in intraoperative costs (p<0.001). The most impactful adjustments to reduce costs included selective use of mesh fixation devices (22.9%) and balloon dissecting trocars (27.6%), reduction in use of disposable scissors (13.8%), and reduction in use of disposable clip appliers (3.7%). Open inguinal hernia costs were reduced from an average (±SD) of $315±$253 in FY13 (n=366) to $288±$130 in FY14 (n=286), an 8.6% reduction in cost (p<0.01). In these cases, both avoiding the use of fixation devices and using less expensive mesh implants were identified as significant factors.
Surgeon education and empowerment may significantly reduce the cost of disposable equipment in laparoscopic and open inguinal hernia repair. This simple educational technique could prove financially beneficial throughout various procedures and disciplines.
我们的目标是确定外科医生关于一次性用品成本的培训对腹股沟疝修补等常见手术术中成本降低的影响。
在2013财年（2013财年）末，我们科室的外科医生获得了普通普外科手术中使用的一次性设备和植入物的成本信息。历史上用品成本较低的外科医生向同事展示了各自的技术。未采用财务激励或惩罚措施来鼓励行为改变。然后使用曼-惠特尼U检验比较了2013财年（2013财年）和2014财年（2014财年）腹腔镜和开放腹股沟疝修补的手术用品成本。
经过外科医生培训后，腹腔镜腹股沟疝修补的平均成本从2013财年的平均1,088±473美元（±标准差）（n = 258）降至2014财年的860±441美元（n = 274），术中成本降低了21.0%（p < 0.001）。降低成本最有效的调整措施包括选择性使用网片固定装置（22.9%）和球囊分离套管针（27.6%）、减少一次性剪刀的使用（13.8%）以及减少一次性施夹器的使用（3.7%）。开放腹股沟疝的成本从2013财年的平均（±标准差）315±253美元（n = 366）降至2014财年的288±130美元（n = 286），成本降低了8.6%（p < 0.01）。在这些病例中，避免使用固定装置和使用成本较低的网片植入物均被确定为重要因素。
外科医生培训和授权可能显著降低腹腔镜和开放腹股沟疝修补中一次性设备的成本。这种简单的培训技术在各种手术和学科中可能在经济上有益。
