title: A Model of Cost Reduction and Standardization: Improved Cost Savings While Maintaining the Quality of Care.
abstract: BACKGROUND
  Surgeon instrument choices are influenced by training, previous experience, and established preferences. This causes variability in the cost of common operations, such as laparoscopic appendectomy. Many surgeons are unaware of the impact that this has on healthcare spending.
  
  
  OBJECTIVE
  We sought to educate surgeons on their instrument use and develop standardized strategies for operating room cost reduction.
  
  
  METHODS
  We collected the individual surgeon instrument cost for performing a laparoscopic appendectomy. Sixteen surgeons were educated about these costs and provided with cost-effective instruments and techniques.
  
  
  METHODS
  This study was conducted in a university-affiliated hospital system.
  
  
  METHODS
  Patients included those undergoing a laparoscopic appendectomy within the hospital system.
  
  
  METHODS
  Patient demographics, operating room costs, and short-term outcomes for the fiscal year before and after the education program were then compared.
  
  
  RESULTS
  During fiscal year 2013, a total of 336 laparoscopic appendectomies were performed compared with 357 in 2014. Twelve surgeons had a ≥5% reduction in average cost per case. Overall, the average cost per case was reduced by 17% (p < 0.001). Switching from an energy device to a stapler load or reusable plastic clip applier resulted in the largest savings per case at $321 or $442 per case. There were no differences in length of stay, 30-day readmissions, postoperative infections, operating time, or reoperations.
  
  
  CONCLUSIONS
  This retrospective study is subject to the accuracy of the medical chart system. In addition, specific instrument costs are based on our institution contracts and vary compared with other institutions.
  
  
  CONCLUSIONS
  In this study we demonstrate that operative instrument costs for laparoscopic appendectomy can be significantly reduced by informing the surgeons of their operating room costs compared with their peers and providing a low-cost standardized instrument tray. Importantly, this can be realized without any incentive or punitive measures and does not negatively impact outcomes. Additional work is needed to expand these results to more operations, hospital systems, and training programs.
authors.affiliation: 1 Department of Surgery, University of Chicago, Chicago, Illinois 2 Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Guzman
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Gitelis
authors.forename: John G
authors.initials: JG
authors.lastname: Linn
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ujiki
authors.forename: Matthew
authors.initials: M
authors.lastname: Waskerwitz
authors.forename: Konstantin
authors.initials: K
authors.lastname: Umanskiy
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Muldoon
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000191:economics* / Q000295:instrumentation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009873:Operating Rooms / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000191:economics*; D014481:United States