Kaiser Permanente South Sacramento, 6600 Bruceville Rd, Sacramento, CA, 95823, USA.
Kaiser Permanente South San Francisco, South San Francisco, CA, USA.
Surg Endosc. 2022 Jan;36(1):800-807. doi: 10.1007/s00464-020-08266-0. Epub 2021 Jan 27.
Healthcare expenditure is on the rise placing greater emphasis on operational excellence, cost containment, and high quality of care. Significant variation is seen in operating room (OR) costs with common surgical procedures such as laparoscopic appendectomy. Surgeons can influence cost through the selection of instrumentation for common surgical procedures such as laparoscopic appendectomy. We aimed to quantify the cost of laparoscopic appendectomy in our healthcare system and compare cost variations to operative times and outcomes.
We performed a retrospective review of laparoscopic appendectomies in a large regional healthcare system during one-year period (2018). Operating room supply costs and procedure durations were obtained for each hospital. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) outcomes and demographics were compared to the costs for each hospital.
A total of 4757 laparoscopic appendectomies were performed at 20 hospitals (27 to 522 per hospital) by 233 surgeons. The average supply cost per case ranged from $650 to $1067. Individual surgeon cost ranged from $197 to $1181. The average operative time was 41 min (range 33 to 60 min). There was no association between lower cost and longer operative time. The patient demographics and comorbidities were similar between sites. There were no significant differences in postoperative complications between high- and low-cost centers. The items with the greatest increase in cost were single-use energy devices (SUD) and endoscopic stapler. We estimate that a saving of over $417 per case is possible by avoiding the use of energy devices and may be as high as $ 984 by adding selective use of staplers. These modifications would result in an annual savings of $1 million for our health system and more than $ 125 million nationwide.
Performing laparoscopic appendectomy with reusable instruments and finding alternatives to expensive energy devices and staplers can significantly decrease costs and does not increase operative time or postoperative complications.
医疗支出不断增加，这使得人们更加注重卓越的运营、成本控制和高质量的医疗服务。常见的手术如腹腔镜阑尾切除术的手术室（OR）成本存在显著差异。外科医生可以通过选择常见手术（如腹腔镜阑尾切除术）的仪器来影响成本。我们旨在量化我们的医疗体系中腹腔镜阑尾切除术的成本，并将成本变化与手术时间和结果进行比较。
我们对一年期间（2018 年）在一个大型区域医疗体系中进行的腹腔镜阑尾切除术进行了回顾性研究。为每个医院获取手术室供应成本和手术持续时间。将美国外科医师学院国家手术质量改进计划（NSQIP）的结果和人口统计学数据与每个医院的成本进行比较。
在 20 家医院（每家医院 27 至 522 例）中，由 233 名外科医生完成了 4757 例腹腔镜阑尾切除术。每例的平均供应成本从 650 美元到 1067 美元不等。个别外科医生的成本从 197 美元到 1181 美元不等。平均手术时间为 41 分钟（范围 33 至 60 分钟）。较低的成本与较长的手术时间之间没有关联。患者的人口统计学特征和合并症在各部位相似。高成本和低成本中心之间在术后并发症方面没有显著差异。成本增加最大的项目是一次性使用能量设备（SUD）和内镜吻合器。我们估计，通过避免使用能量设备，可以使每例手术节省超过 417 美元，如果选择性使用吻合器，节省费用可能高达 984 美元。这些修改将使我们的医疗体系每年节省 100 万美元，全国范围内节省超过 1.25 亿美元。
使用可重复使用的仪器进行腹腔镜阑尾切除术，并寻找昂贵的能量设备和吻合器的替代品，可以显著降低成本，而不会增加手术时间或术后并发症。
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