Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
David G BrauerRyan C Fields

Abstract

Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost-benefit associations will be necessary to justify expenditures in the era of bundled payment structures. All laparoscopic cholecystectomies (LCCKs) performed within a single health system over a 1-year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes. From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs. Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall c...Continue Reading

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Citations

Mar 14, 2018·Annals of Surgery·Christopher P ChildersMelinda Maggard-Gibbons
Jul 26, 2017·Annals of Surgery·Kyle H SheetzMichael J Englesbe
Apr 22, 2017·Journal of Health Services Research & Policy·Nick Black
Nov 30, 2018·Surgical Endoscopy·Elizabeth M PontarelliPandu R Yenumula
Jan 16, 2019·Minimally Invasive Surgery·Trishul KapoorWasef Abu-Jaish
Jul 21, 2020·The American Surgeon·Maria Baimas-GeorgeDavid A Iannitti
Aug 12, 2018·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Christopher P ChildersMelinda Maggard-Gibbons
Oct 11, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Christopher C StahlDaniel E Abbott
Nov 4, 2020·Journal of Pediatric Surgery·Keon Young ParkPeter F Nichol
Jan 28, 2021·Surgical Endoscopy·Lavina MalhotraPandu R Yenumula
Aug 29, 2019·Annals of Surgery·Christopher P ChildersRodrigo F Alban

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