Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization.
BACKGROUND
Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost-benefit associations will be necessary to justify expenditures in the era of bundled payment structures.


METHODS
All laparoscopic cholecystectomies (LCCKs) performed within a single health system over a 1-year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes.


RESULTS
From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs.


CONCLUSIONS
Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall cost, the opportunity exists for improved resource utilization with no obvious risk for a reduction in the quality of care.
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
David G
DG
Brauer
Division of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
William G
WG
Hawkins
Division of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Steven M
SM
Strasberg
Division of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
L Michael
LM
Brunt
Department of Surgical Services, Barnes-Jewish Hospital, St. Louis, MO, USA.
David P
DP
Jaques
BJC Healthcare, St. Louis, MO, USA.
Nicholas R
NR
Mercurio
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.|BJC Healthcare, St. Louis, MO, USA.|John Cochran Veteran's Administration Hospital, St. Louis, MO, USA.|Olin Business School and the Center for Health Policy, Washington University, St. Louis, MO, USA.
Bruce L
BL
Hall
Division of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ryan C
RC
Fields
D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004209:Disposable Equipment / Q000191:economics; D006295:Health Resources / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000592:standards; D006801:Humans; D008923:Missouri; D009873:Operating Rooms / Q000191:economics* / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards; D017064:Process Assessment, Health Care / Q000191:economics* / Q000592:standards; D058996:Quality Improvement / Q000191:economics; D019984:Quality Indicators, Health Care / Q000191:economics; D012189:Retrospective Studies; D013523:Surgical Equipment / Q000191:economics; D016896:Treatment Outcome