title: Use of linear programming to estimate impact of changes in a hospital's operating room time allocation on perioperative variable costs.
abstract: BACKGROUND
  Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating costs. The authors used a detailed hospital cost database to investigate by how much a change in allocations of operating room (OR) time among surgeons can increase perioperative variable costs.
  
  
  METHODS
  The authors obtained financial data for all patients who underwent outpatient or same-day admit surgery during a year. Linear programming was used to determine by how much changing the mix of surgeons can increase total variable costs while maintaining the same total hours of OR time for elective cases.
  
  
  RESULTS
  Changing OR allocations among surgeons without changing total OR hours allocated will likely increase perioperative variable costs by less than 34%. If, in addition, intensive care unit hours for elective surgical cases are not increased, hospital ward occupancy is capped, and implant use is tracked and capped, perioperative costs will likely increase by less than 10%. These four variables predict 97% of the variance in total variable costs.
  
  
  CONCLUSIONS
  The authors showed that changing OR allocations among surgeons without changing total OR hours allocated can increase hospital perioperative variable costs by up to approximately one third. Thus, at hospitals with fixed or nearly fixed annual budgets, allocating OR time based on an OR-based statistic such as utilization can adversely affect the hospital financially. The OR manager can reduce the potential increase in costs by considering not just OR time, but also the resulting use of hospital beds and implants.
authors.affiliation: Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa 52242, USA. Franklin-Dexter@UIowa.edu
authors.forename: Franklin
authors.initials: F
authors.lastname: Dexter
authors.forename: John T
authors.initials: JT
authors.lastname: Blake
authors.forename: Donald H
authors.initials: DH
authors.lastname: Penning
authors.forename: Brian
authors.initials: B
authors.lastname: Sloan
authors.forename: Patricia
authors.initials: P
authors.lastname: Chung
authors.forename: David A
authors.initials: DA
authors.lastname: Lubarsky
mesh_terms: D000066:Accounting; D000465:Algorithms; D000556:Ambulatory Surgical Procedures / Q000191:economics; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures / Q000191:economics; D015276:Health Care Rationing; D009871:Operating Room Nursing / Q000191:economics / Q000458:organization & administration; D009873:Operating Rooms / Q000191:economics* / Q000458:organization & administration*; D010934:Planning Techniques; D011382:Programming, Linear