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.
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Funding
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number T32 CA090217 and T32 ES007015.
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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.
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Stahl, C.C., Udani, S., Schwartz, P.B. et al. Surgeon Variability Impacts Costs in Laparoscopic Cholecystectomy: the Volume-Cost Relationship. J Gastrointest Surg 25, 195–200 (2021). https://doi.org/10.1007/s11605-020-04814-0
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DOI: https://doi.org/10.1007/s11605-020-04814-0