PROVIDER-SPECIFIC VARIATION IN LAPAROSCOPIC CHOLECYSTECTOMY: THE VOLUME-COST RELATIONSHIP
Christopher C. Stahl, University of Wisconsin School of Medicine and Public Health, Madison, WI
Introduction: Variation in practice patterns is a known driver of healthcare expenditures; however previous investigations into surgeon cost variation have been greatly limited by a focus on supply costs in isolation, rather than total hospital costs. We sought to characterize the surgeon-specific factors that drive total hospital perioperative cost variation in laparoscopic cholecystectomy.
Methods: We conducted a retrospective cohort study of patients undergoing laparoscopic cholecystectomy from 2014-2018 at a tertiary care center and affiliated short-stay hospital. Patient and hospital demographics were extracted from the electronic medical record and merged with inflation-adjusted actual hospital cost data (not charges or reimbursements). Multiple linear regression was used to identify surgeon-specific factors associated with increased hospital costs during the perioperative admission.
Results: 1,700 patients populated the final dataset. Operations were performed by 21 surgeons from three divisions, with operative volume ranging from 6 to 182 cases. Median patient age was 47, 72% were female, and 66% of the operations were performed in an outpatient setting. The median perioperative cost was $5098 (IQR $4316-$6834) and median OR time was 67 minutes (IQR 48-92). 41 patients (2.4%) were readmitted within 30 days, and 2 (0.1%) experienced 30-day mortality. After controlling for patient and hospital factors, individual surgeons were associated with significant variability in total cost (parameter estimates ranging from -$1500 to +$2095). High surgeon volume (p<.01) and shorter OR times (p<.01) were associated with lower perioperative costs. Surgeon years in practice, gender, fellowship training, division, and junior attending status were not associated with perioperative cost variation (p=NS).
Conclusion: These data represent the first demonstration of provider-specific variation in laparoscopic cholecystectomy using total hospital costs, rather than supply costs in isolation. In an era of increased scrutiny of the opportunity costs of inefficient health care delivery, these data suggest that procedural allocation to high-volume surgeons could lower perioperative costs.
Figure 1: Relationship between perioperative costs, individual surgeon, and surgeon volume
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