Guzman Michael J, Gitelis Matthew E, Linn John G, Ujiki Michael B, Waskerwitz Matthew, Umanskiy Konstantin, Muldoon Joseph P
1 Department of Surgery, University of Chicago, Chicago, Illinois 2 Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.
Dis Colon Rectum. 2015 Nov;58(11):1104-7. doi: 10.1097/DCR.0000000000000463.
Surgeon instrument choices are influenced by training, previous experience, and established preferences. This causes variability in the cost of common operations, such as laparoscopic appendectomy. Many surgeons are unaware of the impact that this has on healthcare spending.
We sought to educate surgeons on their instrument use and develop standardized strategies for operating room cost reduction.
We collected the individual surgeon instrument cost for performing a laparoscopic appendectomy. Sixteen surgeons were educated about these costs and provided with cost-effective instruments and techniques.
This study was conducted in a university-affiliated hospital system.
Patients included those undergoing a laparoscopic appendectomy within the hospital system.
Patient demographics, operating room costs, and short-term outcomes for the fiscal year before and after the education program were then compared.
During fiscal year 2013, a total of 336 laparoscopic appendectomies were performed compared with 357 in 2014. Twelve surgeons had a ≥5% reduction in average cost per case. Overall, the average cost per case was reduced by 17% (p < 0.001). Switching from an energy device to a stapler load or reusable plastic clip applier resulted in the largest savings per case at $321 or $442 per case. There were no differences in length of stay, 30-day readmissions, postoperative infections, operating time, or reoperations.
This retrospective study is subject to the accuracy of the medical chart system. In addition, specific instrument costs are based on our institution contracts and vary compared with other institutions.
In this study we demonstrate that operative instrument costs for laparoscopic appendectomy can be significantly reduced by informing the surgeons of their operating room costs compared with their peers and providing a low-cost standardized instrument tray. Importantly, this can be realized without any incentive or punitive measures and does not negatively impact outcomes. Additional work is needed to expand these results to more operations, hospital systems, and training programs.
外科医生的器械选择受培训、既往经验和既定偏好的影响。这导致诸如腹腔镜阑尾切除术等常见手术的成本存在差异。许多外科医生并未意识到这对医疗保健支出的影响。
我们旨在就器械使用对外科医生进行培训，并制定降低手术室成本的标准化策略。
我们收集了每位外科医生进行腹腔镜阑尾切除术的器械成本。16位外科医生了解了这些成本，并获得了具有成本效益的器械和技术。
本研究在一家大学附属医院系统中进行。
患者包括在该医院系统内接受腹腔镜阑尾切除术的患者。
然后比较了教育项目前后财政年度的患者人口统计学特征、手术室成本和短期结局。
2013财年共进行了336例腹腔镜阑尾切除术，2014年为357例。12位外科医生的每例平均成本降低了≥5%。总体而言，每例平均成本降低了17%（p<0.001）。从能量器械改用吻合器钉仓或可重复使用的塑料夹应用器，每例节省最多，分别为每例321美元或442美元。住院时间、30天再入院率、术后感染、手术时间或再次手术方面无差异。
这项回顾性研究取决于病历系统的准确性。此外，特定器械成本基于我们机构的合同，与其他机构相比有所不同。
在本研究中，我们证明，通过告知外科医生其与同行相比的手术室成本，并提供低成本的标准化器械托盘，腹腔镜阑尾切除术的手术器械成本可显著降低。重要的是，无需任何激励或惩罚措施即可实现这一点，且不会对结局产生负面影响。需要开展更多工作，将这些结果推广到更多手术、医院系统和培训项目中。
