Do Busier Surgeons Have Lower Intraoperative Costs? An Analysis of Anterior Cervical Discectomy and Fusion Using Time-Driven Activity-Based Costing.

Autor:	Sarikonda A; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Leibold A; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Sami A; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Mansoor Ali D; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Tecce E; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., August A; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., O'Leary M; Department of Medicine, Drexel University College of Medicine., Thalheimer S; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Heller J; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Prasad S; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Sharan A; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Jallo J; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Harrop J; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience., Vaccaro AR; Rothman Orthopedic Institute, Thomas Jefferson, Philadelphia, PA., Sivaganesan A; Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience.
Jazyk:	angličtina
Zdroj:	Clinical spine surgery [Clin Spine Surg] 2024 Apr 10. Date of Electronic Publication: 2024 Apr 10.
DOI:	10.1097/BSD.0000000000001628
Abstrakt:	Study Design: The present study is a single-center, retrospective cohort study of patients undergoing neurosurgical anterior cervical discectomy and fusion (ACDF). Objective: Our objective was to use time-driven activity-based costing (TDABC) methodology to determine whether surgeons' case volume influenced the true intraoperative costs of ACDFs performed at our institution. Summary of Background Data: Successful participation in emerging reimbursement models, such as bundled payments, requires an understanding of true intraoperative costs, as well as the modifiable drivers of those costs. Certain surgeons may have cost profiles that are favorable for these "at-risk" reimbursement models, while other surgeons may not. Methods: Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented. All surgeons performing ACDFs at our primary and affiliated hospital sites from 2017 to 2022 were divided into four volume-based cohorts: 1-9 cases (n=10 surgeons, 38 cases), 10-29 cases (n=7 surgeons, 126 cases), 30-100 cases (n=3 surgeons, 234 cases), and > 100 cases (n=2 surgeons, 561 cases). Results: The average total intraoperative cost per case was $7,116 +/- $2,945. The major cost contributors were supply cost ($4,444, 62.5%) and personnel cost ($2,417, 34.0%). A generalized linear mixed model utilizing Poisson distribution was performed with the surgeon as a random effect. Surgeons performing 1-9 total cases, 10-29 cases, and 30-100 cases had increased total cost of surgery (P < 0.001; P < 0.001; and P<0.001, respectively) compared to high-volume surgeons (> 100 cases). Among all volume cohorts, high-volume surgeons also had the lowest mean supply cost, personnel cost, and operative times, while the opposite was true for the lowest-volume surgeons (1-9 cases). Conclusion: It is becoming increasingly important for hospitals to identify modifiable sources of variation in cost. We demonstrate a novel use of TDABC for this purpose. Level of Evidence: Level-III. Competing Interests: Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Spine Journal, Sentryx Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. The remaining authors declare no conflict of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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