MP24-08 SURGEON VARIATION IN THE COST OF LAPAROSCOPIC NEPHRECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2015MP24-08 SURGEON VARIATION IN THE COST OF LAPAROSCOPIC NEPHRECTOMY Lindsay Hampson, Anobel Odisho, Peter Carroll, and Maxwell Meng Lindsay HampsonLindsay Hampson More articles by this author , Anobel OdishoAnobel Odisho More articles by this author , Peter CarrollPeter Carroll More articles by this author , and Maxwell MengMaxwell Meng More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1150AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Identifying surgical procedures with significant cost variation can identify opportunities for cost savings and standardization. We evaluate one common urologic procedure, laparoscopic nephrectomy (LapNx), to identify variation in surgical case costs. METHODS All LapNx performed at UCSF over a one-year period (9/2012 – 9/2013) were identified. Surgical supply costs were determined as the institution-negotiated rate for each item used during a case. Surgical supply costs, time costs (assuming a monetized case time of $69/minute), and total case costs (supply cost + time cost) were evaluated for each surgeon and analyzed with one-way analysis of variance and pairwise t-tests. Univariate and multivariate analysis of factors associated with case supply cost above the mean cost of the procedure was conducted using multilevel mixed effects logistic regression grouped by surgeon. RESULTS Over a one-year period, 62 LapNx were performed by 5 urologists (volume range 2-28) (Figure 1). Mean case supply cost varied significantly by surgeon (p < 0.01), with a mean supply cost of $2,866.31 per case overall, and individual means ranging from $1,865.61 to $3,909.68. There was statistically significant variation in both time and time cost by surgeon (p < 0.01), with a mean case time of 227.8 minutes (range 106-515) and a mean time cost of $15,718.65 (range $12,126.75 - $25,875.00). Significant variation remained in analyzing the total case cost (p < 0.01), with a mean total case cost of $18,584 (range $13,992.36 - $27,946.34). In univariate and multivariate analysis evaluating years of experience, case-specific surgical volume, or case start after 3 pm, there were no significant associations with supply cost (p > 0.05). CONCLUSIONS There is significant variation in both supply and time costs by surgeon, although surgeon experience and volume do not account for these differences. Linking these data with diagnosis codes may help to determine predictors of increased supply cost. Standardization of this procedure may help to decrease both supply and time costs. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e278 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lindsay Hampson More articles by this author Anobel Odisho More articles by this author Peter Carroll More articles by this author Maxwell Meng More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...