Equipment Variation in Laparoscopic Cholecystectomy

Ayman E Ahmed, MBBS, Sayeed Ikramuddin, MD, Susan M Walters, RN, H. Tracy Davido, MD. University of Minnesota.

Healthcare costs continue to rise while reimbursements are decreasing; furthermore, these reimbursements are increasingly tied to quality outcome metrics. Therefore, methods of improving operative efficiency, consistency and cost reduction are imperative. Prior studies have delineated process variation as a determinant of cost, length of operation and patient morbidity. One method to achieve both improved cost efficiency and patient outcome metrics is reducing variability in surgical equipment use. These processes can be utililized to streamline equipment purchases and storage, and decrease procurement costs. Laparoscopic cholecystectomy is used, for analysis of variance and application of potential methodologies for cost & metric improvements.

Retrospective analysis of costs of equipment sets used by total of 36 surgeons for laparoscopic cholecystectomy in two tertiary medical centers and an affiliated community hospital. Demographic and case volume data for each surgeon was obtained and analyzed by t-testing.

The minimum cost of equipment was $258, while the maximum was $2,755 for a mean of $649 and standard deviation of $423.  A total of 88 pieces of equipment were stocked due to surgeon preferences, but the most efficient surgeon used only 23 items. Cost was not related to specialty of practice, length of residency training, completion of fellowship, number of cholecystectomies, or number of cases performed per year (P=NS).
Surgeons younger than 40 or with minimally invasive fellowship training performed more expensive procedures (P<0.05).

Significant variation exists in equipment utilization for laparoscopic cholecystectomy. As a widely performed laparoscopic procedure, this represents an important opportunity for decreasing costs and variability, while increasing efficiency, and ultimately improving patient care.

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