title: Physician Education on Controllable Costs Significantly Reduces Cost of Laparoscopic Hysterectomy.
abstract: To determine whether educating surgeons about their controllable instrumentation costs by providing cost data on total laparoscopic hysterectomy (LH) would reduce the cost of this procedure.
  
  
  
  Prospective cohort study (Canadian Task Force classification III).
  
  
  
  Academic-affiliated community hospital.
  
  
  
  Patients who underwent LH between April 2014 and March 2015 with surgeons who performed at least 10 LHs during that time period, along with a second group who underwent LH with the same cohort of surgeons between July 2015 and September 2015.
  
  
  
  The cost of LH was calculated for all surgeons who performed more than 10 LHs between April 2014 and March 2015. Itemized cost data were collected. The individual costs, as well as a summary of the data, were shared with all of the physicians to highlight areas of potential cost savings. The costs were then measured for 3 months after the educational intervention (July-September 2015) to gauge the impact of physician cost education.
  
  
  
  Thirteen surgeons met the criteria for inclusion in this analysis. Together, they performed 271 hysterectomies, with an average instrumentation cost of $1539.47 ± $294.16 and an average operating room time of 178 ± 26 minutes. Bipolar instrument choice represented 37% of the baseline costs, followed by 10% for trocar, 9% for cuff closure, and 8% for uterine manipulator. This same group of surgeons performed a total of 69 hysterectomies in the 3-month follow-up period of July-September 2015, with an average instrumentation cost of $1282.62 ± $235.03 and an average operating room time of 163 ± 50 minutes. There was statistically significant cost reduction of $256.85 ± $190.69 (p = .022), with no significant change in operating room time. Bipolar instrument cost decreased significantly, by $130.02 ± $125.02 (p = .021), representing 51% of the total cost savings. Trocar, cuff closure, and uterine manipulator costs were not significant sources of cost savings on average, but did represent sources of cost savings for some surgeons individually.
  
  
  
  Given adequate education about the products available for use in their institution, surgeons make informed decisions regarding the choice of instrumentation, allowing them to directly impact the cost of total LH, resulting in cost savings.
authors: Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina. Electronic address: katherine.croft@carolinashealthcare.org.
authors: Katherine
authors: K
authors: Croft
authors: Department of Obstetrics and Gynecology Florida Hospital Nicholson Center, Celebration, Florida.
authors: Patricia J
authors: PJ
authors: Mattingly
authors: Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina.
authors: Patrick
authors: P
authors: Bosse
authors: Department of Gynecologic Oncology, Carolinas Medical Center, Charlotte, North Carolina.
authors: R Wendel
authors: RW
authors: Naumann
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017046:Cost Savings; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D010535:Laparoscopy / Q000191:economics*; D008875:Middle Aged; D061646:Operative Time; D066231:Surgeons / Q000193:education*
keywords: Bipolar instruments; Cost analysis; Laparoscopic hysterectomy