title: Does anesthesiology residency training result in decreasing intraoperative drug cost from a resident's first to second month's experience in adult cardiac anesthesiology?
abstract: BACKGROUND
  All physicians bear the responsibility of minimizing cost while providing care that meets or exceeds national quality benchmarks. Intraoperative anesthetic drug costs constitute a small but significant fraction of the total cost in the perioperative period. Previous studies have revealed that anesthesiologists are generally unaware of drug costs. In order to determine if experience and education improve anesthetic drug cost containment, we compared the total anesthetic drug cost per case as residents progressed through their rotations in cardiac anesthesia.
  
  
  METHODS
  We considered the total anesthetic drug cost for 202 adult cardiac cases, including coronary artery bypass grafting, mitral valve repair/replacement, and aortic valve repair/replacement. 77 of the cases analyzed were done by residents in their first month of cardiac anesthesia, and 125 were done by residents in their second month of cardiac anesthesia. In the interval between these rotations, residents participate in didactics and other educational activities including a practice management rotation in the CA-3 year where they are exposed to financial topics in healthcare.
  
  
  RESULTS
  The average total drug cost per case for residents in their first month was $193.50; SD= $82.00. The average total cost per case for residents in their second month was $223.30; SD=$96.10. With multivariate analysis considering case type, length of procedure and patient age, the resident training level did not impact the cost in a significant way (p=0.062).
  
  
  CONCLUSIONS
  In the multivariate analysis considering case type, length of procedure and patient age, more experienced residents did not have a significantly different total drug cost per case. This finding suggests that didactic educational efforts and implicit modeling over time did not reduce drug costs in the operating room during adult cardiac surgery.
authors.affiliation: Cardiothoracic Fellow, Ochsner Health System, Department of Anesthesiology.
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Steyn
authors.affiliation: System Vice Chair, Department of Anesthesiology (East Bank) & Community Pain Operations and Cardiothoracic Anesthesiologist.
authors.forename: David M
authors.initials: DM
authors.lastname: Broussard
authors.affiliation: Staff Anesthesiologist, Ochsner Health System, Department of Anesthesiology.
authors.forename: Neil
authors.initials: N
authors.lastname: DiGiovanni
authors.affiliation: Pharmacist, Ochsner Health System, Department of Anesthesiology.
authors.forename: Sheena
authors.initials: S
authors.lastname: Babin
authors.affiliation: Biostatistician, Center for Health Research Ochsner Clinic Foundation.
authors.forename: Adrianna C
authors.initials: AC
authors.lastname: Dornelles