Abstract 10556: A Systematic and Reliable Process for Performing Cost Containment Analysis Within the Operating Room

Abstract

Purpose: Healthcare spending within the United States increased 4.6% in 2019 and represented over $3.8 trillion, or 17.7% of our GDP. The operating margin for most hospitals is 1-3%. As costs continue to rise, insurers will continue to shift these financial risks and responsibilities onto hospitals and hospitals eventually onto surgeons. Methods: Using a recently introduced surgical receipt function within Epic, we set out to develop cost containment strategies within congenital cardiac surgery at Duke University Hospital. Surgical receipt data was obtained between January 1, 2020 and January 1, 2021. Variability in case costs and product utilization were identified. Findings were discussed with surgeons to identify high impact changes with low barriers to implementation. Results: Between January 1, 2020 and January 1, 2021, there were 340 index cases and 449 unique surgical receipts. Four procedures representing 54 patients accounted for more than 50% of the total annual direct operating room supply costs (LVAD, 5 patients, 22.7% of annual costs; Norwood, 20 patients, 12.7%; RV-PA shunt, 16 patients, 9.9%; PVR, 13 patients, 9.4%). Exploration chest for postoperative hemorrhage was associated with the highest variability in case cost. In addition to mechanical devices and valves, cost drivers included the use of disposable vascular clips, suture brand preference between surgeons, and surgical patch material utilization which accounted for 3.7%, 6.6%, and 26.5% of overall annual direct operating room supply costs. Conclusions: We project 6-6.5% in annual savings due to changes in suture and surgical clip utilization. Changes to surgical patch utilization should carry an additional 4-4.5% in savings. The surgical receipt represents a reliable and uniform way of reporting surgical costs with broader implications for all surgical subspecialties.