Mike Mallah, MD, Michael Barringer, MD, Michael Thomason, MD, Elizabeth Ross, MSN, Brent Matthews, MD, Caroline Reinke, MD. Carolinas Medical Center
Introduction: Within our health system of 47 hospitals there is substantial variation in operative supply cost for low-risk minimally invasive surgeries. We hypothesized that after controlling for patient factors, there would be no association between cost and outcome. We also hypothesized that utilization of an energy device would be associated with a shorter operative time.
Methods: We examined operative room (OR) supply cost for all laparoscopic appendectomies and cholecystectomies captured in NSQIP from 1/2015-12/2017 and stratified them by supply cost quartile as well as presence or absence of an energy device. Each quartile was then compared by preoperative risk factors, operative time, and 30-day outcomes. Logistic regression was utilized to examine factors related to a composite outcome and linear regression was utilized to examine factors associated with operative time.
Results: 5,192 NSQIP cases with matched supply cost were identified. Mean supply cost for laparoscopic appendectomy was $927 (IQR $725-$1,063) and for laparoscopic cholecystectomy was $584 (IQR $427-$653). In both groups, significant differences were observed in ASA class, elective vs. urgent vs. emergent status, and wound classification between cost quartiles. Use of an energy device and operative time were also significantly different between the cost quartiles. Rates of postoperative bleeding, organ space SSI, and the composite outcome were differed significantly between cost quartiles for laparoscopic appendectomy, but not laparoscopic cholecystectomy. Increase in supply cost was associated with increased risk of the composite outcome, even after controlling for patient and disease factors (OR 1.06, p=0.04). Mean cost of case was greater and mean operative time was shorter for cases in which an energy device was used ($535 more/6 minutes shorter for cholecystectomy; $259 more/6 minutes shorter for appendectomy; p<0.01 in both). The six minute decreased operative time was evident even after controlling for patient and case characteristics (p<0.01).
Conclusion: Increased supply cost is associated with an increased rate of 30-day postoperative complications, even after controlling for patient and disease characteristics. Use of an energy device increases supply cost, with only a modest decrease in operative time. Standardizing supply cost on patient outcomes across a large group of hospitals and surgeons has the potential to increase value of care for patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95623
Program Number: P647
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster