A Model of Cost Reduction and Standardization

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Abstract
BACKGROUND: Surgeon instrument choices are influenced by training, previous experience, and established preferences. This causes variability in the cost of common operations, such as laparoscopic appendectomy. Many surgeons are unaware of the impact that this has on healthcare spending. OBJECTIVE: We sought to educate surgeons on their instrument use and develop standardized strategies for operating room cost reduction. DESIGN: We collected the individual surgeon instrument cost for performing a laparoscopic appendectomy. Sixteen surgeons were educated about these costs and provided with cost-effective instruments and techniques. SETTINGS: This study was conducted in a university-affiliated hospital system. PATIENTS: Patients included those undergoing a laparoscopic appendectomy within the hospital system. MAIN OUTCOME MEASURES: Patient demographics, operating room costs, and short-term outcomes for the fiscal year before and after the education program were then compared. RESULTS: During fiscal year 2013, a total of 336 laparoscopic appendectomies were performed compared with 357 in 2014. Twelve surgeons had a ≥5% reduction in average cost per case. Overall, the average cost per case was reduced by 17% (p < 0.001). Switching from an energy device to a stapler load or reusable plastic clip applier resulted in the largest savings per case at $321 or $442 per case. There were no differences in length of stay, 30-day readmissions, postoperative infections, operating time, or reoperations. LIMITATIONS: This retrospective study is subject to the accuracy of the medical chart system. In addition, specific instrument costs are based on our institution contracts and vary compared with other institutions. CONCLUSIONS: In this study we demonstrate that operative instrument costs for laparoscopic appendectomy can be significantly reduced by informing the surgeons of their operating room costs compared with their peers and providing a low-cost standardized instrument tray. Importantly, this can be realized without any incentive or punitive measures and does not negatively impact outcomes. Additional work is needed to expand these results to more operations, hospital systems, and training programs.

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