Variation in Tympanoplasty Cost in a Multihospital Network.

Abstract

Identify costs and operative times for tympanoplasty, and evaluate factors influencing cost and time variation. Retrospective cohort study. Multihospital network. Patients undergoing tympanoplasty from 2008 to 2016. Subjects with additional procedures were excluded. A multihospital network's standardized activity-based accounting system was used to determine costs and operative times of tympanoplasty. Correlation between variable factors and cost was calculated by Spearman correlation coefficients. Statistical comparisons of cost and time were made between surgeons and hospitals using an ANOVA test (Kruskal-Wallis) followed by Dunn's test to correct for multiple comparisons. All providers or hospitals with single cases were excluded for statistical comparison. The study cohort included 487 tympanoplasties performed by 44 surgeons at 13 hospitals. Mean patient age was 18.2 ± 17.4 years. Mean cut-to-close time was 85.8 ± 56.7 minutes. Mean total encounter cost was $3491 ± $1,627. Substantial factors associated with total encounter cost were anesthesia cost (r = 0.8782; 95% CI 0.852-0.900, p < 0.001) and cut-to-close time (r = 0.7543; 95% CI 0.707-0.7949, p < 0.001). The total itemized supply cost was less correlated with total encounter cost (r = 0.3176; 95% CI 0.2128-0.4151, p < 0.001). Laser utilization (mean cost $541 ± $343) and artificial graft material (mean cost $199 ± $94) were the major supply costs. Significant variation in tympanoplasty costs exists among different surgeons and hospitals within a multihospital network. Reducing variation in costs while maintaining outcomes may improve healthcare value and eliminate waste.