Advertisement

Surgical Endoscopy

, Volume 33, Issue 7, pp 2339–2344 | Cite as

Regional cost analysis for laparoscopic cholecystectomy

  • Elizabeth M. PontarelliEmail author
  • Gary G. Grinberg
  • Richard S. Isaacs
  • James P. Morris
  • Olakunle Ajayi
  • Pandu R. Yenumula
2018 SAGES Oral
  • 152 Downloads

Abstract

Background

Laparoscopic cholecystectomy is the most common procedure performed by general surgeons in the United States, with approximately 600,000 procedures performed annually. As the cost of care rises, there is increasing emphasis on utilization and quality. Our objective was to evaluate the cost of laparoscopic cholecystectomy in our health system and to compare the operative times and outcomes at high- and low-cost centers.

Methods

We evaluated all laparoscopic cholecystectomies performed in our system over a 1-year period. The operating room supply costs and procedure durations were obtained for each of the hospitals. The American College of Surgeons National Surgical Quality Improvement Program outcomes and demographics were compared to the costs for each hospital.

Results

During the study period, 7601 laparoscopic cholecystectomies were performed at 20 hospitals (170–759/hospital) by 227 surgeons. The average cost per case ranged from $296 at the lowest cost center to $658 at the highest cost center. The average operative time varied between sites from 46 to 95 min. There was no association between cost and operative time or case volume. There was a slight trend toward increased cost with higher number of emergency procedures, but this was not well correlated (R2 = 0.03). The patient demographics and comorbidities were similar between sites. There were no significant differences in postoperative complications between high- and low-cost centers. The items with the greatest increase in cost were disposable trocars, disposable hook cautery, disposable endoscissors, and disposable clip appliers. We estimate that a savings of over $300/case is possible by using reusable instruments, which would result in an annual savings of $1.3 million for our health system, and $285 million nationwide.

Conclusion

Performing laparoscopic cholecystectomy with reusable instruments can significantly decrease costs and does not increase operative time or postoperative complications.

Keywords

Laparoscopic cholecystectomy Cost Utilization Instrument 

Notes

Acknowledgements

We would like to thank Patricia E. Palacios and Tammy S. Peacock for their assistance with the acquisition and management of our datasets.

Compliance with ethical standards

Disclosure

Drs. Pontarelli, Grinberg, Isaacs, Morris, Ajayi, and Yenumula have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Hartman M, Martin AB, Espinosa N, Catlin A, The National Health Expenditure Accounts T (2018) National health care spending. In 2016 spending and enrollment growth slow after initial coverage expansions. Health Aff (Millwood) 37(1):150–160.  https://doi.org/10.1377/hlthaff.2017.1299 CrossRefGoogle Scholar
  2. 2.
    Fingar KR, Stocks C, Weiss AJ, Steiner CA (2014) Most frequent operating room procedures performed in US Hospitals, 2003–2012. HCUP Statistical Brief #186. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb186-Operating-Room-Procedures-United-States-2012.pdf
  3. 3.
    Weiss AJ, Elixhauser A, Andrews RM (2014) Characteristics of operating room procedures in US hospitals 2011. RockvilleGoogle Scholar
  4. 4.
    Traverso LW, Hargrave K (1995) A prospective cost analysis of laparoscopic cholecystectomy. Am J Surg 169(5):503–506CrossRefGoogle Scholar
  5. 5.
    Benchmarks. Lap chole supply costs show wide variation (2000). OR Manager 16 (1):30Google Scholar
  6. 6.
    Macario A, Vitez TS, Dunn B, McDonald T (1995) Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology 83(6):1138–1144CrossRefGoogle Scholar
  7. 7.
    Raft J, Millet F, Meistelman C (2015) Example of cost calculations for an operating room and a post-anaesthesia care unit. Anaesth Crit Care Pain Med 34(4):211–215.  https://doi.org/10.1016/j.accpm.2014.11.002 CrossRefGoogle Scholar
  8. 8.
    Guzman MJ, Gitelis ME, Linn JG, Ujiki MB, Waskerwitz M, Umanskiy K, Muldoon JP (2015) A model of cost reduction and standardization: improved cost savings while maintaining the quality of care. Dis Colon Rectum 58(11):1104–1107.  https://doi.org/10.1097/DCR.0000000000000463 CrossRefGoogle Scholar
  9. 9.
    Brauer DG, Hawkins WG, Strasberg SM, Brunt LM, Jaques DP, Mercurio NR, Hall BL, Fields RC (2015) Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization. HPB (Oxford) 17(12):1113–1118.  https://doi.org/10.1111/hpb.12500 CrossRefGoogle Scholar
  10. 10.
    Adkins HH, Hardacker TJ, Ceppa EP (2016) Examining variation in cost based on surgeon choices for elective laparoscopic cholecystectomy. Surg Endosc 30(7):2679–2684.  https://doi.org/10.1007/s00464-015-4553-7 CrossRefGoogle Scholar
  11. 11.
    Allen RW, Pruitt M, Taaffe KM (2016) Effect of resident involvement on operative time and operating room staffing costs. J Surg Educ 73(6):979–985.  https://doi.org/10.1016/j.jsurg.2016.05.014 CrossRefGoogle Scholar
  12. 12.
    Paolucci V, Schaeff B, Gutt CN, Encke A (1995) Disposable versus reusable instruments in laparoscopic cholecystectomy. A prospective, randomised study. Endosc Surg Allied Technol 3(2–3):147–150Google Scholar
  13. 13.
    Austin LS, Tjoumakaris FP, Ong AC, Lombardi NJ, Wowkanech CD, Mehnert MJ (2017) Surgical cost disclosure may reduce operating room expenditures. Orthopedics 40(2):e269–e274.  https://doi.org/10.3928/01477447-20161116-03 CrossRefGoogle Scholar
  14. 14.
    Gitelis M, Vigneswaran Y, Ujiki MB, Denham W, Talamonti M, Muldoon JP, Linn JG (2015) Educating surgeons on intraoperative disposable supply costs during laparoscopic cholecystectomy: a regional health system’s experience. Am J Surg 209(3):488–492.  https://doi.org/10.1016/j.amjsurg.2014.09.023 CrossRefGoogle Scholar
  15. 15.
    Vigneswaran Y, Linn JG, Gitelis M, Muldoon JP, Lapin B, Denham W, Talamonti M, Ujiki MB (2015) Educating surgeons may allow for reduced intraoperative costs for inguinal herniorrhaphy. J Am Coll Surg 220(6):1107–1112.  https://doi.org/10.1016/j.jamcollsurg.2015.02.030 CrossRefGoogle Scholar
  16. 16.
    Tabib CH, Bahler CD, Hardacker TJ, Ball KM, Sundaram CP (2015) Reducing operating room costs through real-time cost information feedback: a pilot study. J Endourol 29(8):963–968.  https://doi.org/10.1089/end.2014.0858 CrossRefGoogle Scholar
  17. 17.
    Slater M, Booth MI, Dehn TC (2009) Cost-effective laparoscopic cholecystectomy. Ann R Coll Surg Engl 91(8):670–672.  https://doi.org/10.1308/003588409X12486167521154 CrossRefGoogle Scholar
  18. 18.
    Van Meter MM, Adam RA (2016) Costs associated with instrument sterilization in gynecologic surgery. Am J Obstet Gynecol 215(5):652 e651–652 e655.  https://doi.org/10.1016/j.ajog.2016.06.019 Google Scholar
  19. 19.
    Adler S, Scherrer M, Ruckauer KD, Daschner FD (2005) Comparison of economic and environmental impacts between disposable and reusable instruments used for laparoscopic cholecystectomy. Surg Endosc 19(2):268–272.  https://doi.org/10.1007/s00464-003-9232-4 CrossRefGoogle Scholar
  20. 20.
    Schaer GN, Koechli OR, Haller U (1995) Single-use versus reusable laparoscopic surgical instruments: a comparative cost analysis. Am J Obstet Gynecol 173(6):1812–1815CrossRefGoogle Scholar
  21. 21.
    Demoulin L, Kesteloot K, Penninckx F (1996) A cost comparison of disposable vs reusable instruments in laparoscopic cholecystectomy. Surg Endosc 10(5):520–525CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Elizabeth M. Pontarelli
    • 1
    Email author
  • Gary G. Grinberg
    • 1
  • Richard S. Isaacs
    • 2
  • James P. Morris
    • 2
  • Olakunle Ajayi
    • 2
  • Pandu R. Yenumula
    • 1
  1. 1.Kaiser Permanente South SacramentoSacramentoUSA
  2. 2.The Permanente Medical GroupOaklandUSA

Personalised recommendations