Faculty Collaboration Database

Improving the value of care for appendectomy through an individual surgeon-specific approach. J Pediatr Surg 2018 Jun;53(6):1181-1186

Date

04/02/2018

Pubmed ID

29605268

Pubmed Central ID

PMC5994354

DOI

10.1016/j.jpedsurg.2018.02.081

Scopus ID

2-s2.0-85044507642 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

PURPOSE: Standardized care via a unified surgeon preference card for pediatric appendectomy can result in significant cost reduction. The purpose of this study was to evaluate the impact of cost and outcome feedback to surgeons on value of care in an environment reluctant to adopt a standardized surgeon preference card.

METHODS: Prospective observational study comparing operating room (OR) supply costs and patient outcomes for appendectomy in children with 6-month observation periods both before and after intervention. The intervention was real-time feedback of OR supply cost data to individual surgeons via automated dashboards and monthly reports.

RESULTS: Two hundred sixteen children underwent laparoscopic appendectomy for non-perforated appendicitis (110 pre-intervention and 106 post-intervention). Median supply cost significantly decreased after intervention: $884 (IQR $705-$1025) to $388 (IQR $182-$776), p<0.001. No significant change was detected in median OR duration (47min [IQR 36-63] to 50min [IQR 38-64], p=0.520) or adverse events (1 [0.9%] to 6 [4.7%], p=0.062). OR supply costs for individual surgeons significantly decreased during the intervention period for 6 of 8 surgeons (87.5%).

CONCLUSION: Approaching value measurement with a surgeon-specific (rather than group-wide) approach can reduce OR supply costs while maintaining excellent clinical outcomes.

LEVEL OF EVIDENCE: Level II.

Author List

Robinson JR, Carter NH, Gibson C, Brinkman AS, Van Arendonk K, Speck KE, Danko ME, Jackson GP, Lovvorn HN 3rd, Blakely ML

MESH terms used to index this publication - Major topics in bold

Adolescent
Appendectomy
Appendicitis
Child
Child, Preschool
Cost-Benefit Analysis
Female
Hospital Costs
Humans
Infant
Infant, Newborn
Laparoscopy
Male
Operating Rooms
Prospective Studies
Quality of Health Care
Surgeons
Tennessee
Treatment Outcome