Variation and Predictors of Surgical Case Costs among Urologists

Abstract

Introduction: Shifts in the health care delivery system have emphasized providing cost-efficient care. The operating room comprises a significant proportion of hospital costs. Analysis of practice variation in operating room supply use can provide insight into opportunities for cost reduction and improved efficiency without compromising outcomes.

Methods: A retrospective review was conducted of urological procedures performed at the University of California San Francisco Medical Center from September 2012 through December 2015. Supply costs for individual cases were itemized and aggregated using the institution negotiated rate. Operative time was monetized. Supply cost was analyzed with multivariate mixed effects models evaluating surgeon experience and surgeon volume.

Results: The majority of common urological procedures demonstrate significant variation among surgeons in supply, time and overall cost. Surgeon annual procedure specific volume was a significant predictor of lower cost in multivariate analysis of supply cost (p = 0.016) and correlated with a lower likelihood of the case supply cost being in the top quintile (p <0.001). Surgeon experience was not a significant predictor of absolute supply cost or being in the top quintile of supply cost.

Conclusions: Significant variation exists among supply costs of high volume procedures. Higher surgeon procedure specific volume predicts lower operating room supply costs. Targeting procedures with variation for cost optimization via standardization could have a substantial impact on operating room costs and efficiency. The experience of high volume surgeons may be useful to guide optimal supply use given their comparatively lower costs.

Keywords: cost control; cost-benefit analysis; health care costs; operating rooms; urology.

Figure 1.

Example of provider variation within open partial nephrectomy. Red broken line represents median supply cost. Surgeon median costs with interquartile range are shown as box plots. Each dot represents supply cost for individual case performed by that provider.

Figure 2.

Distribution of supply cost by providers across all procedures. Providers listed in descending frequency of median supply cost across all procedures. Each dot represents single operation. Green dots represent cases in bottom supply cost quintile for that specific procedure, red dots represent cases in top supply cost quintile for that specific procedure and grey dots represent cases in middle 3 quintiles.

Figure 3.

Surgeon cases by supply cost quintile. Surgeons listed along x-axis in increasing order based on proportion of cases in top supply cost quintile. Shades represent proportion of each surgeon’s cases in each supply cost quintile.