Hampson Lindsay A, Odisho Anobel Y, Meng Maxwell V
Department of Urology, University of California, San Francisco, San Francisco, California.
Urol Pract. 2018 Sep;5(5):334-341. doi: 10.1016/j.urpr.2017.09.003.
Rising health care costs are leading to efforts to minimize costs while maintaining high quality care. Practice variation in the operating room that is not dictated by patient necessity or clinical guidelines presents an opportunity for cost containment. We identified variation in surgical supply costs among urological surgeons performing laparoscopic nephrectomy and evaluated whether this variation was associated with patient outcomes.
A total of 211 consecutive laparoscopic nephrectomies performed at an academic center between September 1, 2012 and December 31, 2015 were identified and surgical supply costs for each case were determined from the institutional negotiated rate. Patient and surgical factors relevant to case complexity, comorbidity and perioperative outcomes were obtained. Univariate and multivariable analysis of predictors of surgical supply costs and patient outcome as determined by length of stay was conducted.
Median supply cost was $2,537, with individual medians ranging from $1,642 to $4,524, representing a significant variation among surgeons (p <0.01). On multivariable analysis, accounting for patient factors and case complexity, most surgeons remained significant predictors of surgical supply costs. Case supply cost was not a significant predictor of patient outcomes as measured by length of stay on univariate or multivariable analysis controlling for surgeon, patient factors and case complexity.
Significant variation in surgeons' surgical supply costs for laparoscopic nephrectomy exists and is driven by surgeons, and this does not correlate with length of stay. Targeting variation in surgical supply costs in this setting represents an opportunity for cost savings without adversely impacting patient outcomes.
不断上涨的医疗保健成本促使人们在维持高质量医疗的同时努力将成本降至最低。手术室中不受患者需求或临床指南支配的实践差异为成本控制提供了契机。我们确定了进行腹腔镜肾切除术的泌尿外科医生在手术耗材成本方面的差异，并评估了这种差异是否与患者预后相关。
确定了2012年9月1日至2015年12月31日在一家学术中心连续进行的211例腹腔镜肾切除术，并根据机构协商费率确定每例手术的手术耗材成本。获取了与病例复杂性、合并症和围手术期结果相关的患者和手术因素。对手术耗材成本的预测因素以及由住院时间确定的患者预后进行了单变量和多变量分析。
耗材成本中位数为2537美元，个体中位数从1642美元到4524美元不等，这表明外科医生之间存在显著差异（p<0.01）。在多变量分析中，考虑到患者因素和病例复杂性，大多数外科医生仍是手术耗材成本的显著预测因素。在控制了外科医生、患者因素和病例复杂性的单变量或多变量分析中，病例耗材成本并不是以住院时间衡量的患者预后的显著预测因素。
腹腔镜肾切除术外科医生的手术耗材成本存在显著差异，且由外科医生驱动，这与住院时间无关。在这种情况下，针对手术耗材成本的差异是实现成本节约且不会对患者预后产生不利影响的一个机会。
