title: A material cost-minimization analysis for hernia repairs and minor procedures during a surgical mission in the Dominican Republic.
abstract: BACKGROUND
  Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at non-profit organization (NPO) costs would lead to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic.
  
  
  METHODS
  Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost-savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with α = 0.05. Item utilization analyses generated lists of most frequently used materials by procedure type.
  
  
  RESULTS
  The mean cost-savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (n = 13); $332.46 ± $184.09 for bilateral inguinal hernia repair (n = 3); $127.26 ± $13.18 for hydrocelectomy (n = 9); $232.92 ± $56.49 for femoral hernia repair (n = 3); $120.90 ± $30.51 for umbilical hernia repair (n = 8); $36.59 ± $17.76 for minor procedures (n = 26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (n = 7).
  
  
  CONCLUSIONS
  Supply acquisition at NPO costs leads to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for inguinal hernia repair, hydrocelectomy, umbilical hernia repair, minor procedures, and pediatric inguinal hernia repair during a surgical mission in the Dominican Republic. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions.
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA, cavalloj@wudosis.wustl.edu.
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Cavallo
authors.forename: Jenny
authors.initials: J
authors.lastname: Ousley
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Barrett
authors.forename: Sara
authors.initials: S
authors.lastname: Baalman
authors.forename: Kyle
authors.initials: K
authors.lastname: Ward
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Borchardt
authors.forename: J Ross
authors.initials: JR
authors.lastname: Thomas
authors.forename: Gary
authors.initials: G
authors.lastname: Perotti
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Frisella
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D004293:Dominican Republic / Q000208:ethnology; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006552:Hernia, Inguinal / Q000208:ethnology / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics* / Q000295:instrumentation*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008493:Medical Missions / Q000191:economics*; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult