Examining Variation in Cost Based on Surgeon Choices for Elective Laparoscopic Cholecystectomy

Heather H Adkins, MD, MBA, Thomas Hardacker, BA, Eugene Ceppa, MD. Department of Surgery, Indiana University

Introduction: Laparoscopic cholecystectomy is the standard of care for treatment of benign biliary disease. However with declining reimbursements and increasing medical costs, it is imperative for physicians to examine closely their choices for equipment to decrease overall costs, particularly looking at key steps of cholecystectomy. The objective of this study was to examine variations between surgeons in equipment and operating room costs for elective laparoscopic cholecystectomy (LC).

Methods: All elective LC performed at Indiana University Health West Hospital in 2013 were analyzed. Patient demographics, preoperative diagnosis, operative time, surgical equipment, and resident participation were tracked for each case. Exclusion criteria included acute cholecystitis and elective cases that included additional procedures. Electronic medical records for clinical data and administrative records for charges/reimbursement data were reviewed. Total supply costs as well as disposable costs for key portions of the LC were analyzed; including port access, division of cystic duct and artery, dissection of the gallbladder from the liver and specimen removal. Reimbursements were obtained from all payers for LC.

Results: All LC were examined (n=362) and 272 met inclusion criteria. Overall demographics and gallbladder pathology was similar between surgeons. Operative time did not vary significantly between surgeons (range 53 – 98 minutes) with the lowest cost surgeon taking the longest overall time. These times were unaffected by resident participation. The total morbidity and mortality were 6 % and 0% for the study; there were no differences between surgeons. Total supply costs by surgeon ranged from $411-$924. Costs related to key portions of the case had multiple theoretical combinations with the lowest cost being $186. The most cost effective technique used by our surgeons included the use of plastic locking clips and hook electrocautery. The range of reimbursements from payors was $669-$1500.

Conclusion: This study highlights the effect of surgeon choice as it relates to variable costs for surgical technique during an elective LC without compromising safety. However, with healthcare reform and emphasis on reducing healthcare expenditures, it will be vital for surgeons to identify areas of unnecessary cost, as disposable costs can exceed reimbursements. Transparency and tracking by surgeons can lead to data that may support standardization of technique across a healthcare system to lower total supply costs.

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