The economic considerations in laparoscopic surgery

Abstract

There has been increasing concern in the medical, business, and insurance communities and government agencies about the rising cost of health care. Since 1980 the cost of medical care has increased from $280 billion dollars per year to $670 billion dollars in 1990, and was estimated at $900 billion in 1993. Several factors have contributed to this increase, including the high cost of hospitalization and new expensive technology, such as laparoscopic cholecystectomy. This present cost analysis was undertaken to determine the cost variables in laparoscopic cholecystectomy to see if changes in physician, nursing, and administration work activities could decrease the cost of hospitalization. Fifty-four patients who had an uncomplicated elective cholecystectomy during a five-month period in 1993 were assessed in terms of cost components of hospitalization, including nursing unit labor costs, surgery personnel labor costs, supply/instrument cost, and ancillary costs. Nine general surgeons participated in this study, four of whom accounted for 71% of the annual volume of cases. This analysis was performed with the help of Baxter Corporate Consulting, a Division of Baxter Healthcare Corporation. From this study, it was found that the average cost for uncomplicated laparoscopic cholecystectomy patients was $1589±$223. The operating room and supply/instrument component costs were the two largest expenses, accounting for 42% of the total cost. Reimbursement from various insurance agencies were also evaluated, and it was determined that a contract made with a local HMO caused the hospital to lose an average of $443.00 per patient. Instrument cost was evaluated, showing that the surgeons who used disposable instruments had an average instrument cost of $806±$63 per case, whereas those using reusable products had an average cost of $303 per case. (A reprocessing cost of $200 was also added when reusable instruments were used. This included the cost of cleaning, repairs, and labor costs for this equipment.) The cost of disposable and reusable products was evaluated in terms of the initial purchase price, replacement charges, equipment maintenance charges, and labor costs for cleaning, repackaging and inspection, sterilization, and quality control. A second factor identified was that patients directed to an inpatient nursing unit incurred an average direct nursing labor cost of $124, whereas the cost was only $54 when the patient went to an out-patient unit. A third observation demonstrated that the operating room time averaged 203 min±31 min, and the length of the operative procedure accounted for only 96 min±20 min of the total operating room time. From this data it appears that, in hospitals with more than 300 laparoscopic cholecystectomy cases per year, the costs of using reusable and disposable instruments is similar. Time/motion studies in the operating room have also been instituted, along with changes in postoperative physician orders, to decrease the cost of the hospitalization.