Operative expenses compose one-third of the rising health care costs in the United States. Therefore, novel strategies for mitigating cost in the vascular surgery space are warranted. Our institution implemented a cost reduction strategy in 2017 by simply showing surgeons the costs of their implants and disposable supplies at the end of each case in order to increase surgeon financial awareness and reduce costs. We performed a retrospective analysis of recorded supply and implant costs for vascular procedures from 2015 to 2018 at a single institution. Total operative cost was defined as the accumulated implant and supply cost during a procedure. We assessed total implant and disposable supply cost, supply cost alone, and cost per time. Cost was analyzed over two periods: the 24 months prior (PRE) to the tool implementation and 24 months following (POST) with a 1-month washout. Medians and interquartile ranges were calculated for each parameter and compared using the Mann-Whitney U test. We analyzed a total of 1372 procedures performed over the time period studied. Total supply and implant cost (–17.5%; P = .008), supply cost (–1.99%; P = .049) and cost per minute (–28.24%; P = .015) all saw significant reductions across the composite of open procedures from the PRE to POST time point (Table). Largest supply cost reductions were seen in common femoral artery endarterectomy (–42%; P < .001). The total operative cost/time was most significantly reduced for carotid endarterectomy (–8.89%; P = .001), abdominal aortic aneurysm repair (–16.21; P = .019), carotid-subclavian bypass (–9.94%; P = .032), and common femoral endarterectomy (–41.16%; P = .06), with nonsignificant cost reductions in arteriovenous grafting and rib resection. Relative price increases of 31%, 8%, and 3% were calculated for temporal artery biopsy, vein transposition, and distal bypass, respectively. The composite of all endovascular procedures saw large implant cost increases with minimal change in supply cost. We demonstrate that a low-cost, highly implemenTable cost sheet is effective at reducing cost in vascular surgery. Further investigations should assess how and why surgeons choose supplies and implants in order to target further intraoperative cost savings.TableCost trends before and after implementation of a cost sheet across multiple vascular surgery proceduresProcedureTotal operative cost (supply + implant), $Supply cost, $Total cost/time (supply + implant), $/minutePREPOST% ΔP valuePREPOST% ΔP valuePREPOST% ΔP valueCarotid endarterectomy504.3 (411.5-664)452.6 (409.5-525.7)–10.25.012250.3 (238.5-277)249.1 (235-276.1)–0.45.35344.86 (4.05-6.09)4.43 (3.77-5.25)–8.89.001AAA repair1686 (1268-2041)1399 (1257-1717)–17.01.037542.5 (432-602.5)536.8 (456.6-621.8)–1.052.81857.59 (5.67-9.49)6.36 (1.65-8.13)–16.21.019Carotid-subclavian bypass681 (609.1-805.4)682.6 (641-771.6)0.23.953272.3 (245.8-385.7)259.9 (245.1-290)–4.54.36155.49 (4.52-6.36)4.85 (1.39-5.76)–9.94.032Common femoral endarterectomy3102 (1107-5232)971.3 (532.5-4309)–68.69.0107662.4 (441.3-886.1)382.8 (237.8-566.8)–42.21<.000114.35 (6.32-14.35)8.45 (3.81-8.45)–41.16.061Arteriovenous graft181.8 (130.8-189.2)183.3 (123.8-223.1)0.822.5425113.8 (108.3-132.4)112.5 (106.7-125.9)1.0865.54112.07 (1.39-10.57)1.70 (1.48-2.67)–17.65.14Rib resection119.7 (115.8-124.6)116.6 (112.2-149.2)–2.577.8662120.3 (117.8-123)114.6 (109.7-138.3)–4.738.05621.46 (1.25-2.06)1.39 (1.02-2.11)–4.46.56Temporal artery biopsy45.25 ( 34.41-73.4)90.26 (47.84-121.4)99.49.000345.25 (34.41-73.4)90.55 (48.17-121.4)100.01.00041.38 (0.79-1.79)1.81 (1.25-3.05)30.92.0099Upper extremity vein transposition181.9 (125.1-249)187.7 (132.2-269.2)3.16.5116127.2 (113-145.7)114.9 (101.3-121.1)–9.669.00081.89 (1.02-2.84)2.05 (1.39-2.56)8.68.53Distal bypass831.7 (491.8-2315)767.6 (480-2987)–7.69.8428308.8 (244.9-382.6)377.9 (242.4-572)22.36.08172.64 (1.87-7.98)2.72 (1.59-8.29)3.26.94All endovascular (EVAR + TEVAR)17653 (12890-24376)22524 (15366-29092)27.59.00022031 (1581-2588)2022 (1559-2597)0.437.8103180.3 (11.4-262.1)163.2 (97.84-271.4)–9.48.6396All open549 (275.1-1115)452.7 (209.3-782.4)–17.54.0078250.3 (141.1-411.1)245.3 (121.5-343.2)1.99.04935.237 (2.039-11.03)3.758 (1.86-7.241)–28.24.015AAA, Abdominal aortic aneurysm; EVAR, endovascular aneurysm repair; POST, the 24 months following tool implementation; PRE, The 24 months prior to the tool implementation; TEVAR, thoracic endovascular aneurysm repair.Values are median (interquartile range). Open table in a new tab