Cost Analysis and Supply Utilization of Laparoscopic Cholecystectomy

Trishul Kapoor, MSIV¹, Sean Wrenn, MD², Wasef Abu-Jaish, MD, FACS, FASM, BS². ¹University of Vermont College of Medicine, ²University of Vermont Medical Center

Introduction: Laparoscopic cholecystectomy is one of the most commonly performed procedures in the United States. As one of the highest volume surgeries being performed on an annual basis at our academic medical center, cost analysis is essential to ensure the actual cost of the surgery is minimized without compromising the safety and quality of patient outcomes. We hypothesized there is a statistically significant intra-departmental cost variance with supply utilization variability amongst surgeons of different background and subspecialty.

Methods: This retrospective observational review evaluated 372 laparoscopic cholecystectomy cases (performed by 12 unique surgeons) from June 2015 to June 2016. Surgeons with a case volume of 5 or less were excluded. The 12 surgeons were subdivided into cohorts based on specialty: 2 in bariatric surgery (BS), 5 in acute care surgery (ACS), and 5 in general surgery (GS). The study utilized the Surgical Profitability Compass Procedure Cost Manager System (The Advisory Board Company) to stratify case volume, supply cost, case duration, case severity level, and patient length-of-stay intra-departmentally (BS, ACS, and GS). Supply cost was further analyzed by individual supply units by impact rating and total cost contribution. Statistical methods included a simple comparison of percentages, t-Test, and one-way ANOVA.

Results: Average composite supply cost per case was $569 (US Dollars). The mean case volume distribution was 133 (BS), 109 (ACS), and 130 (GS). The mean intra-departmental total supply cost variance was (P<0.005) with $674.5 (BS), $567.8 (ACS), and $529 (GS). ACS and GS presented with a higher standard deviation of cost – $98 (ACS) and $110 (GS) versus $26 (BS). The mean case duration distribution was statistically significant (P<0.02) with 70 min (BS), 104 min (ACS), and 75.8 (GS). There was no statistically significant difference in mean case severity level (P<0.7) between Bariatric Surgery (1.6), Acute Care Surgery (1.9), and General Surgery (1.9). The average patient length-of-stay distribution (P<0.001) was 1.15 (BS), 3.1 (ACS), and 1.17 (GS).

Conclusion: Overall, there was a statistically significant difference in mean supply cost. The highest supply cost per case was in bariatric surgery and the lowest in general surgery. However the higher surgical supply costs may be attenuated by decreased operative time and post-procedure length of stay. Strategies to reduce total supply cost per case include mandating exchange of expensive items, standardization of supply sets, increased cost transparency, and enhanced education to surgeons regarding equipment pricing. Future studies will include incentive and intervention-based cost reduction.