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INTRODUCTION: The Surgical Safety Checklist (SSC) has been introduced as a proven tool to significantly improve patient safety and outcomes through effective communication of the surgical team. It has been suggested that the SSC can reduce healthcare associated cost through reduction in postoperative complications. However, the impact of a SSC on operating room (OR) cost is not known. This study compares outcomes and direct OR costs for laparoscopic incisional hernia repair (LIHR) before and after implementation of a standardized SSC.
METHODS: In September 2010, our institution implemented a standardized SSC. We retrospectively reviewed all patients that underwent LIHR at our hospital for 1-year prior (PRE) and 1-year after (POST) implementation. Demographic data included age, sex, BMI, ASA score and previous laparotomy. Measures of OR efficiency and cost included operative times (OT), implant cost and total direct OR cost (TDORC). There was no change in vendor contract pricing during the timeframe of this study. Outcomes included length of hospital stay (LOS), and 30-day morbidity and mortality rates. Statistical analysis by student's t-test and Fisher's exact test where appropriate.
RESULTS: A total of 154 patients were identified; 79 PRE and 75 POST group. There were no significant differences between groups for age (p=0.9), gender (p=0.7), BMI (p=0.7), ASA score (p=0.4) and previous laparotomy (p=0.9). Although mean OT was 12 min shorter in the POST group, the difference was not significant (176.1 vs. 164.5; min p=0.2). However, was a significant reduction in implant cost ($2081 vs. $879; p=0.02) and TDORC ($3630 vs. $2463; p=0.03) in the POST group. There was no difference in LOS (1.5 vs.1.6 days p=0.8), surgical site infection rate (2.5% vs. 4%; p=0.9, total complication rates (18.1% vs. 12.8%; p=0.4), readmission (3.8% vs. 9.3%; p=0.28) and reoperation rates (3.8% vs. 5.3%; p=0.9) between groups. There was one death reported in the study.
CONCLUSIONS: Our data indicate that implementation of a standardized SSC is associated with a significant reduction in implant cost and TDORC for patients undergoing LIHR. We speculate that these cost savings are a direct result of an improvement in effective communication between surgical team members regarding special equipment and implant needs for these complex cases. Further studies are required to determine the impact of our SSC on direct OR cost at an institutional level.