Where Are the Costs in Perioperative Care? Analysis of Hospital Costs and Charges for Inpatient Surgical Care

Abstract

Comment This provocative investigation led the authors to estimate that intraoperative anesthesia costs constitute merely 5.6% of the total hospital cost of an inpatient surgical procedure. Moreover, only about half of these costs were classified as direct or variable and thus subject to the anesthesiologist's clinical decisionmaking and potentially substrate for savings. The message is clear: restricting the use of “expensive” drugs will have minimal impact on total costs. If one assumes that hospital departments with the largest proportion of costs have the highest potential for cost reduction, then decreasing operating room and patient ward costs is likely to produce the greatest economy for surgical inpatients. Clearly, the challenge is to achieve cooperation among nurses, anesthesia personnel, surgeons, and administrators to develop effective strategies to enhance productivity and minimize inefficiency. The authors take care to mention that their study did not evaluate ambulatory procedures, nor did it assess the influence of physician practice patterns on “downstream” events in the hospitalization, some of which may have considerable fiscal impact (e.g., superior pain control in high-risk patients who may sustain fewer postoperative complications and have a shorter duration of hospitalization).