Surgeon Variability Impacts Costs in Laparoscopic Cholecystectomy: the Volume-Cost Relationship
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SSAT PLENARY PRESENTATION
Surgeon Variability Impacts Costs in Laparoscopic Cholecystectomy: the Volume-Cost Relationship Christopher C. Stahl 1 & Shreyans Udani 1 & Patrick B. Schwartz 1 & Taylor Aiken 1 & Alexandra W. Acher 1 & James R. Barrett 1 & Jacob A. Greenberg 1 & Daniel E. Abbott 1 Received: 15 May 2020 / Accepted: 30 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Physician variation in adherence to best practices contributes to the high costs of health care. Understanding surgeon-specific cost variation in common surgical procedures may inform strategies to improve the value of surgical care. Methods Laparoscopic cholecystectomies at a single institution were identified over a 5-year period and linked to an institutional cost database. Multiple linear regression was used to control for patient-, case-, and hospital-specific factors while assessing the impact of surgeon variability on cost. Results The final dataset contained 1686 patients. Higher surgeon volume (reported in tertiles) was associated with decreased costs ($5354 vs. $6301 vs. $7156, p < 0.01) and OR times (66 min vs. 85 min vs. 95 min, p < 0.01). After controlling for patient-, case-, and hospital-specific factors, non-MIS fellowship training type (p < 0.01) and low surgeon volume (p < 0.01) were associated with increased costs, while time in practice did not contribute to cost variation (p = NS). Conclusions Surgeon variability contributes to costs in laparoscopic cholecystectomy. Some of this variability is associated with operative volume and fellowship training. Collaboration to limit this cost variability may reduce surgical resource utilization. Keywords Laparoscopic cholecystectomy . Costs . Surgeon volume
Introduction The high costs of US health care are well known and only continue to grow; health care spending reached $3.6 trillion 1 dollars in 2018, accounting for 17.7% of the US GDP. Continued efforts to curb these costs and provide high-value 2 (quality outcomes per dollar spent) care are critical. Cutting waste from the health care delivery system has the potential to 3 decrease costs while preserving outcomes. While physicians have not historically viewed themselves as responsible for reducing health care costs (identifying insurers, hospitals, health systems, and lawyers as groups that need to decrease costs), waste associated with a failure to Meeting Presentation: This work was to be a plenary presentation at the 61st Annual Meeting of the Society for Surgery of the Alimentary Tract, May 2–5, 2020, Chicago, IL. * Christopher C. Stahl [email protected] 1
Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
adopt best care practices was estimated to contribute between 3,4 $102 and $154 billion in wasteful spending in 2011. Provider variability (in adherence to best practices) contributes to this spending. Surgical health care expenditures comprise 30% of US health care spending, and surgeon variabilit
