3 years ago

Surgeon Variation in Intraoperative Supply Cost for Pancreaticoduodenectomy: Is Intraoperative Supply Cost Associated with Outcomes?

With increased scrutiny on the quality and cost of healthcare, surgeons must be mindful of their outcomes and resource utilization. We evaluated surgeon-specific intraoperative supply cost (ISC) for pancreaticoduodenectomy and examined whether ISC was associated with patient outcomes. Study Design Patients undergoing open pancreaticoduodenectomy between January 2012 and March 2015 were included. Outcomes were tracked prospectively through postoperative day 90. ISC was defined as the facility cost of single-use surgical items and instruments, plus facility charges for multi-use equipment. Multivariate logistic regression was used to test associations between ISC and patient outcomes using repeated measures at the surgeon level. Results 249 patients met inclusion criteria. Median ISC was $1,882 (IQR $1,497 - $2,281). Case volume for six surgeons ranged from 18 to 66. Median surgeon-specific ISC ranging from $1,496 to $2,371. Greater case volume was associated with decreased ISC (p<0.001). Overall, ISC was not predictive of postoperative complications (p=0.702) or total hospitalization expenditures (p=0.195). At the surgeon level, surgeon-specific ISC was not associated with the surgeon-specific incidence of severe complication or any wound infection (p>0.227 for both) but was associated with delayed gastric emptying (p=0.004) and postoperative pancreatic fistula (p<0.001). Conclusions In a single-institution cohort of 249 pancreaticoduodenectomies, high-volume surgeons tended to be low-cost surgeons. Across the cohort, intraoperative supply cost was not associated with outcomes. At the surgeon level, associations were noted between ISC and complications, but these may be attributable to unmeasured differences in the postoperative management of patients. These findings suggest that quality improvement efforts to restructure resource utilization towards more cost-effective practice may not affect patient outcomes, although prospective monitoring of safety and effectiveness must be of the utmost concern.

Publisher URL: www.sciencedirect.com/science

DOI: S1072751517320215

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