title: Reducing healthcare costs facilitated by surgical auditing: a systematic review.
abstract: BACKGROUND
  Surgical auditing has been developed in order to benchmark and to facilitate quality improvement. The aim of this review is to determine if auditing combined with systematic feedback of information on process and outcomes of care results in lower costs of surgical care.
  
  
  METHODS
  A systematic search of published literature before 21-08-2013 was conducted in Pubmed, Embase, Web of Science, and Cochrane Library. Articles were selected if they met the inclusion criteria of describing a surgical audit with cost-evaluation.
  
  
  RESULTS
  The systematic search resulted in 3608 papers. Six studies were identified as relevant, all showing a positive effect of surgical auditing on quality of healthcare and therefore cost savings was reported. Cost reductions ranging from $16 to $356 per patient were seen in audits evaluating general or vascular procedures. The highest potential cost reduction was described in a colorectal surgical audit (up to $1,986 per patient).
  
  
  CONCLUSIONS
  All six identified articles in this review describe a reduction in complications and thereby a reduction in costs due to surgical auditing. Surgical auditing may be of greater value when high-risk procedures are evaluated, since prevention of adverse events in these procedures might be of greater clinical and therefore of greater financial impact.
  This systematic review shows that surgical auditing can function as a quality instrument and therefore as a tool to reduce costs. Since evidence is scarce so far, further studies should be performed to investigate if surgical auditing has positive effects to turn the rising healthcare costs around. In the future, incorporating (actual) cost analyses and patient-related outcome measures would increase the audits' value and provide a complete overview of the value of healthcare.
authors.affiliation: Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands, J.A.Govaert@lumc.nl.
authors.forename: Johannes Arthuur
authors.initials: JA
authors.lastname: Govaert
authors.forename: Anne Charlotte Madeline
authors.initials: AC
authors.lastname: van Bommel
authors.forename: Wouter Antonie
authors.initials: WA
authors.lastname: van Dijk
authors.forename: Nicoline Johanneke
authors.initials: NJ
authors.lastname: van Leersum
authors.forename: Robertus Alexandre Eduard Mattheus
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: Michael Wilhemus Jacobus Maria
authors.initials: MW
authors.lastname: Wouters
mesh_terms: D017046:Cost Savings; D017048:Health Care Costs; D006801:Humans; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000592:standards*