A material cost-minimization analysis for hernia repairs and minor procedures during a surgical mission in the Dominican Republic

Abstract

Introduction: Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at non-profit organization (NPO) costs would lead to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic.

Methods: Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost-savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with α = 0.05. Item utilization analyses generated lists of most frequently used materials by procedure type.

Results: The mean cost-savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (n = 13); $332.46 ± $184.09 for bilateral inguinal hernia repair (n = 3); $127.26 ± $13.18 for hydrocelectomy (n = 9); $232.92 ± $56.49 for femoral hernia repair (n = 3); $120.90 ± $30.51 for umbilical hernia repair (n = 8); $36.59 ± $17.76 for minor procedures (n = 26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (n = 7).

Conclusion: Supply acquisition at NPO costs leads to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for inguinal hernia repair, hydrocelectomy, umbilical hernia repair, minor procedures, and pediatric inguinal hernia repair during a surgical mission in the Dominican Republic. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions.

Figure 1

Percent of total disability-adjusted life years (DALYs), years lost to disability (YLDs), years of life lost (YLLs), and total deaths due to inguinal or femoral hernia globally (data for both sexes and all ages from year 2010).

Figure 2

Percent of disability-adjusted life years (DALYs) due to inguinal or femoral hernia in the Dominican Republic (data for both sexes and all ages from year 2010). [EN= early neonatal period (0–6 days); LN= late neonatal period (7–28 days); PN= post neonatal period (29–365 days)]

Figure 3

Percent of years lost to disability (YLDs) due to inguinal or femoral hernia in the Dominican Republic (data for both sexes and all ages from year 2010). [EN= early neonatal period (0–6 days); LN= late neonatal period (7–28 days); PN= post neonatal period (29–365 days)]

Figure 4

Percent of years of life lost (YLLs) due to inguinal or femoral hernia in the Dominican Republic (data for both sexes and all ages from year 2010). [EN= early neonatal period (0–6 days); LN= late neonatal period (7–28 days); PN= post neonatal period (29–365 days)]

Figure 5

Percent of total deaths due to inguinal or femoral hernia in the Dominican Republic (data for both sexes and all ages from year 2010). [EN= early neonatal period (0–6 days); LN= late neonatal period (7–28 days); PN= post neonatal period (29–365 days)]

Figure 6

Perioperative anesthesia material supply item and medication recording document.