Elizabeth T Embick, MD1, Michael Bieri2, Tracy J Koehler, PhD1, Amanda Yang, MD1. 1Spectrum Health/Michigan State University General Surgery Residency, 2Spectrum Health
INTRODUCTION: As the cost of health care increases in the United States, increasing focus has been put on efficiency, cost reduction, and containment of spending. Operating room costs play a significant role in this spending. We investigated whether surgeon education and universal preference cards can have an impact on reducing the equipment costs for common laparoscopic general surgery procedures.
METHODS: This study was designed as a retrospective cohort study at two institutions in a single health system. In January 2015, general surgeons at both institutions participated in an education session about the costs of the operative equipment used to perform laparoscopic appendectomies and laparoscopic cholecystectomies. At one of these institutions, the surgeons then agreed on a universal equipment preference card to be available for every case with other equipment opened only by request. At the other, no universal preference cards were created, and surgeons were free to modify their own existing equipment cards. Equipment cost data for all laparoscopic appendectomies and cholecystectomies was collected for each of these institutions from before the intervention date (July 2014-December 2014) and after (February 2015-November 2017). Laparoscopic appendectomies and cholecystectomies that were performed by surgeons in groups that had not participated in the intervention were excluded from the data.
RESULTS: When comparing pre- and post- data for all procedures at both institutions, there was a statically significant decrease in total supply cost for procedures performed before and after the interventions (pre (n=539) $483.90 vs post (n=3478) $459.10, p = 0.018). The significant cost difference persisted when each type of procedure was compared separately (appendectomies p=0.006, cholecystectomies p=0.018). At the institution that intervened only with education, there was an overall increase in equipment costs for cholecystectomies and appendectomies over the study period, although this was not statistically significant. At the institution that intervened with education and universal preference cards, there was a statistically significant decrease in costs over the study period (p=0.019). This significant difference persisted for each procedure when analyzed separately (p=0.001& p<0.001).
CONCLUSIONS: Surgeon education alone does not significantly reduce operating room disposable supply costs for a prolonged period of time. Surgeon education, when combined with the implementation of universal preference cards, does significantly maintain reductions in operating room supply costs. As the cost of health care continues to increase in the United States and internationally, universal preference cards can be an effective tool to contain cost for common laparoscopic general surgery procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95844
Program Number: S162
Presentation Session: OR Efficiency & Outcomes
Presentation Type: Podium