Isch Emily L, Kozlowski Gabrielle, Self D Mitchell, Habarth-Morales Theodore E, Somers Sydney, Sivaganesan Ahilan, Kim David, McMahon Heather, Newman Andrew, Jenkins Matthew
From the Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
Plast Reconstr Surg Glob Open. 2025 Jun 24;13(6):e6865. doi: 10.1097/GOX.0000000000006865. eCollection 2025 Jun.
The rising complexity and cost of healthcare in plastic surgery, particularly in resource-intensive procedures like free flap and breast reconstruction, pose significant financial challenges. Time-driven activity-based costing (TDABC) offers a method to accurately assess these costs by mapping each step of the care cycle based on time and resources consumed. Although TDABC has been utilized in high-cost fields such as neurosurgery and spine surgery, its application in plastic surgery remains underexplored. This systematic review evaluates the literature on TDABC use in plastic surgery to identify key cost drivers and propose strategies for cost-efficiency.
A systematic review was conducted on studies applying TDABC, activity-based costing, and cost-to-charge ratio in plastic surgery, sourced from PubMed. Inclusion criteria focused on peer-reviewed studies from the last decade assessing costing strategies in aesthetic and reconstructive plastic surgery, resulting in 17 studies that provided empirical data on cost drivers and resource allocation.
Operating room time, staffing, and postoperative care are identified as primary cost contributors in complex reconstructive surgery, with TDABC highlighting inefficiencies such as prolonged operating room time and unnecessary intensive care unit stays. Cost-saving opportunities were found in optimizing postoperative care and reallocating tasks to lower-cost personnel.
TDABC provides a framework for cost optimization in plastic surgery by offering granular insights into resource utilization, allowing for targeted interventions that reduce expenses without compromising care quality. Future research should explore the application of TDABC to cosmetic procedures and assess its long-term cost-effectiveness in plastic surgery.
整形手术中医护保健的复杂性和成本不断上升，尤其是在游离皮瓣和乳房重建等资源密集型手术中，这带来了重大的财务挑战。时间驱动作业成本法（TDABC）提供了一种方法，通过根据消耗的时间和资源对护理周期的每个步骤进行映射，来准确评估这些成本。尽管TDABC已在神经外科和脊柱外科等高成本领域得到应用，但其在整形手术中的应用仍未得到充分探索。本系统评价评估了关于TDABC在整形手术中应用的文献，以确定关键成本驱动因素并提出成本效益策略。
对来自PubMed的应用TDABC、作业成本法和成本收费比率的整形手术研究进行了系统评价。纳入标准侧重于过去十年中评估美容和重建整形手术成本核算策略的同行评审研究，结果有17项研究提供了关于成本驱动因素和资源分配的实证数据。
手术室时间、人员配备和术后护理被确定为复杂重建手术中的主要成本因素，TDABC突出了手术室时间延长和不必要的重症监护病房停留等低效率问题。在优化术后护理和将任务重新分配给低成本人员方面发现了节省成本的机会。
TDABC通过提供对资源利用的详细洞察，为整形手术中的成本优化提供了一个框架，允许在不影响护理质量的情况下进行有针对性的干预以降低费用。未来的研究应探索TDABC在美容手术中的应用，并评估其在整形手术中的长期成本效益。
