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A material cost-minimization analysis for hernia repairs and minor procedures during a surgical mission in the Dominican Republic

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Abstract

Introduction

Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at non-profit organization (NPO) costs would lead to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic.

Methods

Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost-savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with α = 0.05. Item utilization analyses generated lists of most frequently used materials by procedure type.

Results

The mean cost-savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (n = 13); $332.46 ± $184.09 for bilateral inguinal hernia repair (n = 3); $127.26 ± $13.18 for hydrocelectomy (n = 9); $232.92 ± $56.49 for femoral hernia repair (n = 3); $120.90 ± $30.51 for umbilical hernia repair (n = 8); $36.59 ± $17.76 for minor procedures (n = 26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (n = 7).

Conclusion

Supply acquisition at NPO costs leads to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for inguinal hernia repair, hydrocelectomy, umbilical hernia repair, minor procedures, and pediatric inguinal hernia repair during a surgical mission in the Dominican Republic. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions.

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Acknowledgments

Funding for this study was provided by the Foundation for Barnes-Jewish Hospital (St Louis, MO, USA). Jaime A. Cavallo is supported by a KM1 Comparative Effectiveness Research (CER) Career Development Award (KM1CA156708) through the National Cancer Institute (NCI) of the National Institutes of Health (NIH); and the Washington University in St Louis Clinical and Translational Science Award (CTSA) program (UL1TR000448) through the National Center for Advancing Translational Sciences (NCATS) of the NIH. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NCI, the NCATS, or the NIH.

Disclosures

Dr. Cavallo has received research grant funding for unrelated studies from theNIH, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGEs), and the AHS in collaboration with Davol® Incorporated. Dr. Barrett has received non-financial material support for an unrelated research study from Mobisante® Incorporated. Ms. Frisella has received funding from Atrium Medical Corporation® and W. L. Gore and Associates® Incorporated for unrelated service contracts; and research grant funding from the Foundation for Barnes-Jewish Hospital for this research study. Dr. Matthews has served on advisory boards for the Musculoskeletal Transplant Foundation, Covidien® Incorporated, and Synthes® Incorporated; has served as a consultant for Atrium Medical Corporation®; has received speaking fees or honoraria from Atrium Medical Corporation®, Davol® Incorporated, Ethicon® Incorporated, W.L. Gore and Associates® Incorporated; has received payments for authorship of an unrelated publication from McMahon Group® Incorporated; has received research grant funding for unrelated research studies from Covidien® Incorporated, Ethicon® Incorporated, Karl Storz Endoscopy America® Incorporated, Kensey Nash Corporation®, Musculoskeletal Transplant Foundation, Synovis Surgical Innovations®, SAGEs, and the NIH; and has received research grant funding from the Foundation for Barnes-Jewish Hospital for this research study. Ms. Ousley, Ms. Baalman, Dr. Ward, Ms. Borchardt, Mr. Thomas, and Mr. Perotti have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA

    Jaime A. Cavallo, Sara Baalman, Margaret M. Frisella & Brent D. Matthews

  2. Meharry Medical College, Nashville, TN, USA

    Jenny Ousley

  3. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Christopher D. Barrett

  4. William Beaumont Army Medical Center, El Paso, TX, USA

    Kyle Ward

  5. Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA

    Malgorzata Borchardt, J. Ross Thomas & Gary Perotti

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  1. Jaime A. Cavallo
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Correspondence to Jaime A. Cavallo.

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Cavallo, J.A., Ousley, J., Barrett, C.D. et al. A material cost-minimization analysis for hernia repairs and minor procedures during a surgical mission in the Dominican Republic. Surg Endosc 28, 747–766 (2014). https://doi.org/10.1007/s00464-013-3253-4

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