Operating Theatre Costs Research Articles

Direct healthcare costs of oral cancer: A retrospective study from a tertiary care center

The aim of this study was to retrospectively evaluate the direct costs of OSCC treatment and postsurgical surveillance in a tertiary hospital in northeast Italy.Sixty-three consecutive patients surgically treated for primitive OSCC at S. Orsola Hospital in Bologna (Italy) between January 2018 and January 2020 were analyzed. Billing records of the Emilia Romagna healthcare system and institutional costs were used to derive specific costs for the following clinical categories: operating theatre costs, intensive and ordinary hospitalization, radiotherapy, chemotherapy, postsurgical complications, visits, and examinations during the follow-up period. The study population comprised 17 OSCC patients classified at stage I, 14 at stage II, eight at stage III, and 24 at stage IV.The estimated mean total direct cost for OSCC treatment and postsurgical surveillance was €26 338.48 per patient (stage I: €10 733, stage II: €19 642.9, stage III: €30 361.4, stage IV: €39 957.2). An advanced diagnosis (stages III and IV), complex surgical procedure, and loco-regional recurrences resulted in variables that were significantly associated with a higher cost of OSCC treatment and postsurgical surveillance.Redirection of funds used for OSCC treatment to screening measures may be an effective strategy to improve overall health outcomes and optimize national health resources.

Does anyone know how much NHS operating rooms cost? A survey of operating room managers' knowledge of costs and data

Background/Aims Operating theatres represent a large proportion of NHS healthcare resources, so there has been focus on reducing costs in this area. This, in part, relies on managers having knowledge of the relevant costs in operating rooms. This study aimed to gauge the level of familiarity regarding costs among the various tiers of managers of NHS operating theatres, and if this information informed their decision making. Methods A semi-structured interview was administered to 12 finance managers, theatre managers and board members across 16 separate hospitals, representing six NHS trusts. Responses were reviewed through qualitative analysis by the authors. Findings The respondents showed very limited knowledge of operating theatre costs, with nearly all being unable to use cost data to inform either daily or longer-term strategic decision making. In particular, the costs of under- or over-running operating lists were not known. Conclusions The study suggests that heuristics of operating theatre management are, in practice, not influenced by costs. Instead, the resulting cost balance appears to be a passive consequence of decision-making based on other factors. This has significant implications for cost reduction initiatives and suggests an urgent need for improvement.

Bariatric surgery-related costs in Australia now largely driven by operating theatre costs

Bariatric surgery-related costs in Australia now largely driven by operating theatre costs

An Assessment of Comparative Marginal Costs to Non-Robotic Surgery for Radical Prostatectomy amongst Public Patients

Objective: Surgical procedures assisted by robotic technology have been increasing in uptake, particularly in private hospitals. Unlike most of the studies on robotic technology which were sponsored by pecuniary interests of the dominant Monopoly supplier, this paper is an independent investigators’ initiated study of comparative health system costs in a Local Health District on Robotic Surgery (RS) versus Non-RS for patients undergoing prostatectomy amongst a cohort of public patients. The report was limited to understanding the cost implications of RS and productivity savings associated with it via consistently reduced length of stay (LOS). Patient benefits were not formally measured or assessed. Methods: Estimated marginal costs of both RS and Non-RS were ascertained via cost modelling Activity Based Funding (ABF) cost bucket categories for each inpatient separation for Non-RS radical prostatectomy and comparing these to actual costs for patients undergoing RS for radical prostatectomy. This approach compared the expected non-theatre costs of both RS and Non-RS, and considered appropriate cost bucket comparators for operating theatre costs. Results: The results are in congruence with established literature, RS costs are higher than Non-RS. Specifically, this study found that RS yielded a productivity saving to the health system of two days shorter LOS, than Non-RS. However, the marginal cost per separation of RS prostatectomy is $3086 higher than Non-RS prostatectomy in the instruments and consumables costs. Any potential savings associated with reduced LOS do not offset the higher marginal costs associated with RS. Conclusion: Instruments and consumables for RS remain as monopoly products, save for competitive forces; the health system costs for RS are likely to remain significantly higher than non-RS.

Automated Surgical Term Clustering: A Text Mining Approach for Unstructured Textual Surgery Descriptions.

High costs in health care and everlasting need for quality improvement in care delivery is increasingly becoming the motivating factor for novel predictive studies in health care informatics. Surgical services impact both the operating theatre costs and revenues and play critical role in care quality. Efficiency of such units relies extremely on effective operational planning and inventory management. A key ingredient to such planning activities is the structured and unstructured data available prior to the surgery day from the electronic health records and other information systems. Unstructured data, such as textual features of procedure description and notes, provide additional information while structured data alone is not sufficient. To effectively utilize textual information using text mining, textual features should be easily identifiable, i.e., without typographical errors and ad hoc abbreviations. While there exists numerous spelling correction and abbreviation identification tools, they are not suitable for the surgical medical text as they require a dictionary and cannot accommodate ad hoc words such as abbreviations. This study proposes a novel preprocessing framework for surgical text data to detect misspellings and abbreviations prior to the application of any text mining and predictive modeling. The proposed approach helps extract the most salient text features from the unstructured principal procedure and additional notes by effectively reducing the raw feature set dimension. The transformed (text) feature set thus improves subsequent prediction tasks in surgery units. We test and validate the proposed approach using datasets from multiple hospitals' surgical departments and benchmark feature sets.

Chance-constrained admission scheduling of elective surgical patients in a dynamic, uncertain setting

In the present contribution, a chance-constrained scheduling model is presented for determining admission dates of elective surgical patients. The admission scheduling model is defined considering a dynamic, stochastic decision-making environment. The primary aim of the model concerns the minimization of operating theatre costs and patient waiting times, while simultaneously avoiding bed shortages at a fixed certainty level through a chance-constrained formulation. This stochastic model is implemented by means of sample average approximation and is solved by a meta-heuristic algorithm. To illustrate the applicability of the model, the approach is used to implement four admission scheduling policies on this dynamic decision-making setting that are evaluated on different criteria in a computational study using simulation. The results show that the stochastic approach is able to account for the uncertainty in patients’ length of stay and surgical procedure duration, enabling it to avoid bed shortages while still optimizing operating theatre costs and patient waiting times.

Management of acute appendicitis in an acute surgical unit: a cost analysis.

The acute surgical unit (ASU) model of acute general surgery care offers efficient patient assessment, improved clinical outcomes and has been demonstrated to be cost-efficient. Despite this, the management of acute appendicitis in our ASU was found to be highly cost-negative. This study sought to identify the drivers of increased cost. A retrospective cost analysis of all patients with uncomplicated acute appendicitis in 2016 was undertaken to investigate the drivers of increased cost. The patient-level costing approach was used to assign cost to patients. The ASU management of uncomplicated appendicitis was found to have made a net loss of $625 000 in 2016. This study identified that the three largest cost drivers in appendicitis care were hospital overheads, bed day length of admission cost and operating theatre costs. Radiology, pathology and pharmacy costs did not affect total cost significantly. Two key targets for improvement were identified. First, reduced theatre turnaround times will allow more efficient theatre utilization. Second, improved after-hours and weekend theatre availability will reduce preoperative waiting time-related cost.

Complications and costs in primary knee replacement surgery in an endoprosthetics centre : Influence of state of training

This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S‑Op, T‑Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T‑Op and S‑Op were examined. The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S‑Op and those who had been operated by a T‑Op was made for all parameters. Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p‑o day. The T‑Op required an average of 11 min more than the S‑Op. CRP was significantly higher in the T‑Op group only on the third p‑o day, by 18 mg/l. In contrast, in the T‑Op group, a blood loss of 181 ml was lower than in the S‑Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S‑Op and T‑Op. In the setting of a certified endoprosthetics centre, the comparison of T‑Op with S‑Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.

Word balloon catheter for Bartholin's cyst and abscess as an office procedure: clinical time gained.

BackgroundAround 2 % of women develop a Bartholin’s cyst or abscess at least once in their life time. The use of Word balloon catheter as an office procedure for the management of Bartholin’s cyst and abscess has been well described and indicates high patient acceptance, low short-term recurrence rates and reduced cost. In most of the reported studies, the reduced costs are attributed to savings from equipment cost, operating theatre costs and health personnel costs. An evaluation of the actual clinical time gained with this office procedure has not been reported and hence the rationale for this study. This study was conducted from December 2011 to January 2014 on 35 patients. An initial retrospective clinical audit of 14 cases of marsupialization under general anesthetic between December 2011 and December 2012 was performed. The findings were compared with a subsequent prospective observational service evaluation of 21 consecutive patients between December 2012 and January 2014.ResultsCompared to marsupialization under general anesthetic, the mean clinical time gained from admission to insertion of Word balloon catheter as an office procedure is 15 h and 40 min and the mean clinical time gained from admission to discharge is at least 24 h. There were very few minor complications and no major complications in the Word catheter group compared to the marsupialization group.ConclusionsThere is a clinically significant time gained with the use of Word balloon catheter as an office procedure compared to marsupialization under general anesthetic for Bartholin’s cyst and abscess. The findings from our study could assist other units that want to adopt this procedure justify the efficiency savings in terms of clinical time gained when a business case is submitted. Further studies are needed to investigate and address the underlying causes for the delays encountered when marsupialization under general anesthetic is chosen by patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1795-3) contains supplementary material, which is available to authorized users.

Minimally invasive oesophagectomy more expensive than open despite shorter length of stay

The minimally invasive oesophagectomy (MIO) approach offers a number of advantages over open approaches including reduced discomfort, shorter length of stay and a faster recovery to baseline status. On the other hand, minimally invasive procedures typically are longer and consume greater disposable instrumentation, potentially resulting in a greater overall cost. The objective of this study was to compare costs associated with various oesophagectomy approaches for oesophageal cancer. An institutional Resource Information Management System (RIMS) was queried for cost data relating to hospital expenditures (as opposed to billings or collections). The RIMS was searched for patients undergoing oesophagectomy for oesophageal cancer between 2003 and 2012 via minimally invasive, open transthoracic (OTT) (including Ivor Lewis, modified McKeown or thoracoabdominal) or transhiatal approaches. Patients that were converted from minimally invasive to open, or involved hybrid procedures, were excluded. A total of 160 oesophagectomies were identified, including 61 minimally invasive, 35 open transthoracic and 64 transhiatal. Costs on the day of surgery averaged higher in the MIO group ($12 476 ± 2190) compared with the open groups, OTT ($8202 ± 2512, P < 0.0001) or OTH ($5809 ± 2575, P < 0.0001). The median costs associated with the entire hospitalization also appear to be higher in the MIO group ($25 935) compared with OTT ($24 440) and OTH ($15 248). The average length of stay was lowest in the MIO group (11 ± 9 days) compared with OTT (19 ± 18 days, P = 0.006) and OTH (18 ± 28 days P = 0.07). The operative mortality was similar in the three groups (MIO = 3%, OTT = 9% and OTH = 3%). The operating theatre costs associated with minimally invasive oesophagectomy are significantly higher than OTT or OTH approaches. Unfortunately, a shorter hospital stay after MIO does not consistently offset higher surgical expense, as total hospital costs trend higher in the MIO patients. In an increasingly strained health care economy, efforts to reduce costs associated with the minimally invasive approach should address the inpatient hospitalization as well as operating theatre expenses.

Evaluation of the cost of laparoscopic and open cholecystectomy.

Despite the rapid growth of laparoscopic cholecystectomy, the comparative costs of this new procedure and open cholecystectomy remain unknown. In this study the costs have been evaluated of a consecutive series of patients undergoing these procedures in a district general hospital with an established resource management centre. Fifty consecutive patients undergoing open cholecystectomy between June 1988 and July 1990 immediately before the introduction of laparoscopic cholecystectomy and 100 patients undergoing laparoscopic cholecystectomy between August 1990 and June 1992 were studied. Costs estimated prospectively for each patient were compared. The mean cost per patient of open cholecystectomy was estimated at 2102 pounds compared with 2026 pounds for the first 50 patients undergoing the laparoscopic procedure. The mean cost (1744 pounds) for the second 50 patients undergoing laparoscopic cholecystectomy was less than that for either open cholecystectomy (P < 0.005) or the initial 50 laparoscopic operations (P < 0.03). Operating theatre costs and equipment costs were higher in both laparoscopic groups. These were offset by the higher nursing and ward costs of open cholecystectomy. For the laparoscopic procedure the operating theatre times and duration of hospital stay were both less in the second 50 patients than in the first 50. After the initial learning period, laparoscopic cholecystectomy is less expensive than the open operation and represents a cost-effective method for treatment of the patient with gallstones.

Oculoplastic reconstruction following Mohs surgery.

Mohs micrographic surgery has been advocated as the optimal management of nonmelanoma skin cancer in the periocular region. It is a technique that is ideally suited to the removal of skin tumours with a contiguous growth pattern such as basal cell carcinoma and squamous cell carcinoma, allowing examination of 100% of the surgical margin. As a result of this total margin control, the technique offers an unsurpassed curve rate combined with maximal preservation of normal tissue. Following excision of a periocular tumour by a Mohs surgeon, the resulting defect usually requires reconstruction. Our objective was to determine whether the size of defect produced by Mohs surgery and the type of reconstruction required differed from the results we would have expected from standard surgery with a 3 mm excision margin. A Mohs surgery service with a combined dermatological and oculoplastic approach was set up in Manchester in 1994. We reviewed 60 of our patients who underwent Mohs surgery and compared the size of defect produced as well as the type of reconstruction required with the results we would have predicted for standard excisional surgery with a 3 mm margin. Although a minority of patients required larger reconstructions than would have been anticipated (20%), many had smaller reconstructions than we had predicted (37%). This latter group often had important structures preserved, and therefore had the benefit of less extensive reconstructive surgery. Excision of a periocular tumour by Mohs surgery may occasionally identify extensive subclinical tumour extension and so produce an unexpectedly large defect for reconstruction. Many patients, however, require less extensive reconstructive surgery than would have been predicted. This produces benefits in terms not only of improved cosmesis and eyelid function, but also reduced operating theatre costs.

Cost-effectiveness of free tissue transfer.

In a review of 61 patients with compound injuries to the upper and lower extremities. Operating Theatre costs were added to the costs of inpatient hospitalization after commencement of reconstruction with either a pedicled flap or free tissue transfer. The cost of pedicled groin flap to the upper limb and cross leg flap groups was double that of comparable free tissue transfer groups. The cost of abdominal tube pedicle to the lower limb was three times greater than for the free flap technique. The conclusion is drawn that apart from general advantages to the patient, the cost to the community is significantly reduced.