A Sustainable Solution for Reducing Draping Waste in Cleft Surgeries.

OBJECTIVE: This study aims to reduce the waste generated from primary cleft lip and/or palate (CL/P) repair. DESIGN: A retrospective chart review examined a single surgeon's experience with CL/P repair using standard draping technique and reduced draping technique. Fisher's exact tests were performed comparing complication rates between techniques. SETTING: All procedures were conducted at a single academic medical center under the care of a board-certified pediatric plastic surgeon and fellowship-trained pediatric anesthesiologists. PATIENTS: The study included all patients ≤ 24 months of age who underwent primary CL/P repair using a reduced draping technique at the senior author's institution. An equivalent number of patients who underwent CL/P repair by the senior author immediately prior to implementation of the reduced draping technique were included for comparison. INTERVENTION: Patients undergoing CL/P repair before the change in technique were draped using the standard CL/P draping. The senior author then switched to using a reduced draping on all CL/P repairs afterwards. MAIN OUTCOME MEASURES: Weights and costs of both draping sets were obtained and differences calculated. A manual chart review was performed to assess rates of accidental intraoperative extubation, postoperative infection, fistula formation, and wound dehiscence. RESULTS: The implementation of a reduced draping technique resulted in a 530 gram weight savings and $7.49 cost savings per procedure. Fisher's exact tests revealed no statistically significant differences in complication rates except for oral mucosal dehiscence, which was lower in the reduced draping group. CONCLUSIONS: Reduced draping in CL/P repairs significantly reduces operative waste without compromising surgical outcomes.

Operative Time, Cost, and Union Rate of Power Rasp Joint Preparation Versus Traditional Preparation in Arthrodesis of the Foot and Rearfoot.

Time spent in the operating room is valuable to both surgeons and patients. One of the biggest rate-limiting factors when it comes to arthrodesis procedures of the foot and ankle is cartilage removal and joint preparation. Power instrumentation in joint preparation provides an avenue to decrease joint preparation time, thus decreasing operating room time and costs. Arthrodesis of 47 joints (n) from 27 patients were included. Power rasp joint preparation in 26 joints was compared to traditional osteotome and curette joint preparation in 21 joints in both time (seconds), cost (total operating room time cost per minute), and union rate. The overall mean joint preparation time using power rasp for the subtalar joint was 268.3 seconds, talonavicular joint 212.3 seconds, calcaneocuboid joint 142.6 seconds, 1st TMT 107.2 seconds. Mean joint preparation time using traditional method for subtalar joint 509.8 seconds, talonavicular joint 393.0 seconds, calcaneocuboid joint 400.0 seconds, 1st TMT 319.6 seconds. Mean cost of joint preparation using power rasp for subtalar joint $165.47, talonavicular joint $130.89, calcaneocuboid joint $87.94, 1st TMT $66.11. Mean cost of joint preparation using traditional techniques for subtalar joint $314.34, talonavicular joint $242.35, calcaneocuboid joint $246.67, 1st TMT $197.33. Overall union rate was 98% (1 asymptomatic non-union). Increasing efficiency in the operating room is vital to every surgeon's practice. Power rasp joint preparation is a viable option to increase efficiency and decrease operative time, this study shows no statistically significant differences in union rate, with comparable rates to existing literature.

Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: preoperative planning, patient satisfaction, and improved resident skills.

BACKGROUND: Proximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study's objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients. MATERIALS AND METHODS: Twenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated. RESULTS: Intraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention. CONCLUSIONS: Fewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims. LEVEL OF EVIDENCE: Level I, prospective randomized case-control study.

Modified alveolar ridge preservation to promote the osteogenesis of the distal surface of second molar after mandibular impacted third molar extraction: a preliminary study.

OBJECTIVES: The objective of the retrospective study was to explore whether the use of a modified alveolar ridge preservation technique impacts osteogenesis on the distal surface of the second molar after mandibular third molar (M3) extraction. MATERIALS AND METHODS: A total of 54 patients were enrolled in this study and divided into three different groups, including modified alveolar ridge preservation (MARP) group, traditional tooth extraction (TRA) group, and classical guided bone regeneration (GBR) group. In this study, MARP was designed with the highlights of the preservation of the alveolar bone superior and lingual to M3. These patients chose different surgical methods according to their own wishes for past infection or in order to prevent pericoronitis, and the operation time and surgical cost of each group were recorded. The periodontal conditions of the ipsilateral mandibular second molar (M2) and the height of its distal alveolar bone were measured during the postoperative follow-up. RESULTS: The probing depth, clinical attachment level, and osseous defect depth on the distal surface of the ipsilateral M2 in the MARP group were better than those of the TRA group at any time of the follow-up (P < 0.05 for all), but there was no statistical difference in the measurements when compared to the GBR group at 6 months after operation (P > 0.05 for all). CONCLUSIONS: Thus, MARP therapy not only improves the regeneration of periodontal osseous defects distal to the M2 after M3 extraction but also reduces the operation time and surgical cost. CLINICAL RELEVANCE: This paper introduces a modified surgical method that can not only economically and effectively remove the impacted mandibular third molar but also obtain stable osteogenesis.

Robotic Cholecystectomies: What Are They Good for? - A Retrospective Study - Robotic versus Conventional Cases.

INTRODUCTION: Robot-assisted cholecystectomies are often criticized as expensive with uncertain benefit to patients. Characterization of robotic surgery benefits, as well as specific factors that drive cost, has the potential to shape the current debate. METHODS: The surgical cost and outcomes among patients who underwent robotic (n = 283) or non-robotic (n = 1438) laparoscopic cholecystectomies between 2012 and 2018 at a single academic institution were examined retrospectively. All cholecystectomies were primary surgical procedures with no secondary procedures. We also examined the subset of robotic (n = 277) and non-robotic (n = 1108) outpatient procedures. RESULTS: Robotic cholecystectomies were associated with higher median total cost compared to conventional procedures, largely attributable to variable costs and surgical costs. Patients who underwent conventional cholecystectomy had longer mean lengths of stays (1.7 versus 1.1 days) compared to robotic procedures-with over 10 times as many requiring hospital admission. CONCLUSIONS: At present, robotic cholecystectomies have a little value to patients and institutions outside of surgical training. Prior to narrowing the analysis to outpatient cases, difference in total cost between procedures was less pronounced due to more frequent inpatient management following conventional procedures. Future optimization of robotic consumables and free market competition among system manufacturers may increase financial feasibility by decreasing variable costs associated with robotic surgery.

Cost Awareness of Common Supplies Is Severely Impaired Among All Members of the Surgical Team.

BACKGROUND: Increased health care spending concerns have generated interest in reducing operating room (OR) costs, but the cost awareness of the surgical team selecting intraoperative supplies remains unclear. This work characterizes knowledge of supply cost among surgeons and OR staff in a large academic hospital and seeks to examine the role of experience and training with regards to cost insight. METHODS: This work is a cross-sectional study of surgeons, trainees, nurses, and surgical technicians (n = 372) across all surgical specialties at a large academic hospital. Participants completed a survey reporting frequency of use and estimated cost for 11 common surgical supplies as well as opinions on access to cost information in the OR. Cost estimation error was expressed as the ratio of estimated-to-actual cost, and groups were compared with one-way analysis of variance and chi-squared testing. Spearman correlation (ρ) was used to describe the relationship between monotonic variables. RESULTS: Overestimation error was universal and ranged widely (3.80-49.79). There was no significant difference in estimation accuracy when stratified by role or years of experience. Less expensive items had higher rates of estimation error than more expensive items (P < 0.001), and a moderately strong relationship was found between decreased item cost and increased estimation error (ρ: 0.49). The overwhelming majority (91%) of respondents expressed a desire to learn more about supply pricing. CONCLUSIONS: Price knowledge of common supplies is globally impaired for entire surgical team but coexists with a strong desire to augment cost awareness. Improved access to cost information has a high potential to inform surgical decision-making and decrease OR waste.

Variation in resource utilization associated with the surgical management of ovarian cancer.

OBJECTIVE: Identify the major factors that drive standardized cost in providing surgical care for women with ovarian cancer, characterize the magnitude of variation in resource utilization between centers, and to investigate the relationship between resource utilization and quality of care provided. METHODS: Retrospective cohort study of hospitals across the United States reporting to the Premier Database who cared for patients with ovarian cancer diagnosed between 2007 and 2014. The primary outcome was standardized total cost of the index hospitalization. To assess the relationship between hospital standardized costs and patient outcomes, we identified four measures of quality: 1) complications, 2) re-operation, 3) length of stay > 15 days, and 4) unplanned readmission. RESULTS: The study population included 15,857 patients treated at 226 hospitals. The median standardized cost for hospitalizations was $13,267 (IQR = $3342). Reoperation was associated with 49% increase (95% CI = 43%-56%), and having minor complication was associated with 10% (95% CI = 8%-12%) increase in standardized cost, a moderate complication was associated with 36% (95% CI = 33%-38%) increase, and a major complication was associated with 83% (95% CI = 76%-89%) increase. The average risk-adjusted hospital standardized costs for hospitals in the highest resource use quartiles was 56% higher than the average hospital costs for hospitals in the lowest quartile ($10,826 vs. $16,933). The largest variation was in operating room standardized cost (45.5% of the total variation in operating room cost is explained by differences in hospital practices) and supplies (41.7%). CONCLUSIONS: We identified significant variation in standardized costs among women who underwent surgery for ovarian cancer, operating room and supply costs are the largest drivers of variation.

Effects of a Surgical Receipt Program on the Supply Costs of Five General Surgery Procedures.

BACKGROUND: Surgical supplies occupy a large portion of health care expenditures but is often under the surgeon's control. We sought to assess whether an automated, surgeon-directed, cost feedback system can decrease supply expenditures for five common general surgery procedures. MATERIALS AND METHODS: An automated "surgical receipt" detailing intraoperative supply costs was generated and emailed to surgeons after each case. We compared the median cost per case for 18 mo before and after implementation of the surgical receipt. We controlled for price fluctuations by applying common per-unit prices in both periods. We also compared the incision time, case length booking accuracy, length of stay, and postoperative occurrences. RESULTS: Median costs decreased significantly for open inguinal hernia ($433.45 to $385.49, P < 0.001), laparoscopic cholecystectomy ($886.77 to $816.13, P = 0.002), and thyroidectomy ($861.21 to $825.90, P = 0.034). Median costs were unchanged for laparoscopic appendectomy and increased significantly for lumpectomy ($325.67 to $420.53, P < 0.001). There was an increase in incision-to-closure minutes for open inguinal hernia (71 to 75 min, P < 0.001) and laparoscopic cholecystectomy (75 to 96 min, P < 0.001), but a decrease in thyroidectomy (79 to 73 min, P < 0.001). There was an increase in booking accuracy for laparoscopic appendectomy (38.6% to 55.0%, P = 0.001) and thyroidectomy (32.5% to 48.1%, P = 0.001). There were no differences in postoperative occurrence rates and length of stay duration. CONCLUSIONS: An automated surgeon-directed surgical receipt may be a useful tool to decrease supply costs for certain procedures. However, curtailing surgical supply costs with surgeon-directed cost feedback alone is challenging and a multimodal approach may be necessary.

Surgical follow-up costs disproportionately impact low-income patients.

BACKGROUND: Surgical procedures have significant costs at the national level, but the financial burden on patients is equally important. Patients' out-of-pocket costs for surgery and surgical care include not only direct medical costs but also the indirect cost of lost wages and direct nonmedical costs including transportation and childcare. We hypothesized that the nonmedical costs of routine postoperative clinic visits disproportionately impact low-income patients. MATERIALS AND METHODS: This was a cross-sectional study performed in the postoperative acute care surgery clinic at a large, urban county hospital. A survey containing items about social, demographic, and financial data was collected from ambulatory patients. Nonmedical costs were calculated as the sum of transportation, childcare, and lost wages. Costs and cost to income ratios were compared between income strata. RESULTS: Ninety-seven patients responded to the survey of which 59 reported all items needed for cost calculations. The median calculated cost of a clinic visit was $27 (interquartile range $18-59). Components of this cost were $16 ($14-$20) for travel, $22 ($17-$50) for childcare among patients requiring childcare, and $0 ($0-$30) in lost wages. Low-income patients had significantly higher (P = 0.0001) calculated cost to income ratios, spending nearly 10% of their monthly income on these costs. CONCLUSIONS: The financial burden of routine postoperative clinic visits is significant. Consistent with our hypothesis, the lowest income patients are disproportionately impacted, spending nearly 10% of their monthly income on costs associated with the clinic visit. Future cost-containment efforts should examine alternative, lower cost methods of follow-up, which reduce financial burden.

Accurate Preoperative and Intraoperative Evaluation Reduces Surgical Costs and Patient Invasiveness in Ventriculoperitoneal Shunt Revision.

The ventriculoperitoneal (VP) shunt is one of the most common surgical procedures in neurosurgery, frequently resulting in malfunctions. Shunt malfunctions, which can include mechanical failure, obstruction, infection, or disconnection, occur in a significant percentage of patients, often necessitating multiple revisions. These revisions can lead to increased healthcare costs due to additional surgeries or treatments. Therefore, addressing the economic impacts of these revisions is crucial. Our report presents a cost-effective approach to shunt revisions, demonstrated through a case study of an 82-year-old woman with hydrocephalus. Although initially treated with a VP shunt, she required a revision after six years due to shunt malfunction. Through comprehensive preoperative and intraoperative evaluations, including a shuntogram with iodine contrast and meticulous examination, we identified the cause of malfunction as a connective tissue sac blocking the peritoneal catheter. The surgery involved flushing the catheter lumen with saline to confirm the obstruction and careful removal of the obstructive tissue. This accurate diagnosis facilitated a minimally invasive revision, enabling the reuse of existing shunt components and avoiding the need for new devices, thus reducing costs and surgical invasiveness. Our study serves as a call to action for healthcare providers and surgeons to consider more cost-effective and patient-friendly approaches in managing VP shunt malfunctions, ultimately benefiting both the healthcare system and the patients it serves.

Comparative Analysis of Surgical Durations and Fees Across Eight Types of Glaucoma Surgery Performed by a Single Surgeon.

The duration of several types of glaucoma surgery and reimbursement amounts per minute of surgery remain unknown. This study compared the surgical duration of glaucoma procedures (ab interno trabeculotomy, PreserFlo, ab externo trabeculotomy, bleb revision, EXPRESS, trabeculectomy, Ahmed, and the Baerveldt implant) and their reimbursement amounts in Japan. We retrospectively analyzed 30 consecutive surgeries of each type of glaucoma surgery. The reimbursement amount per surgical hour was calculated by subtracting the implant cost from the total medical fees. Amounts were converted to dollars based on an exchange rate of 1 USD = 133 JPY. The average surgical time was as follows: ab interno trabeculotomy, 7.8 ± 2.1; PreserFlo, 13.5 ± 4.0; ab externo trabeculotomy, 15.2 ± 4.1; bleb revision, 15.6 ± 2.3; EXPRESS, 16.9 ± 2.7; trabeculectomy, 18.5 ± 3.1; Ahmed, 35.8 ± 8.2; and Baerveldt, 39.2 ± 6.2. The reimbursement amounts after implant deduction were as follows: ab interno trabeculotomy, $1,089; PreserFlo, $1,538; ab externo trabeculotomy, $1,430; bleb revision, $259; EXPRESS, $1,600; trabeculectomy, $1,774; Ahmed, $1,600; and Baerveldt, $1,765. Reimbursement amounts per minute varied, with the highest and lowest for ab interno trabeculotomy and bleb revision at $140 per minute and $17 per minute, respectively. Reimbursement amounts per minute of surgery for eight types of glaucoma surgery vary by up to eightfold.

The downtrending cost of robotic bariatric surgery: a cost analysis of 47,788 bariatric patients.

The surgical robot is assumed to be a fixed, indirect cost. We hypothesized rising volume of robotic bariatric procedures would decrease cost per patient over time. Patients who underwent elective, initial gastric bypass (GB) or sleeve gastrectomy (SG) for morbid obesity were selected from Florida Agency for Health Care Administration database from 2017 to 2021. Inflation-adjusted cost per patient was collected. Cost-over-time ($/patient year) and change in cost-over-time were calculated for open, laparoscopic, and robotic cases. Linear regression on cost generated predictive parameters. Density plots utilizing area under the curve demonstrated cost overlap. Among 76 hospitals, 11,472 bypasses (223 open, 6885 laparoscopic, 4364 robotic) and 36,316 sleeves (26,596 laparoscopic, 9724 robotic) were included. Total cost for robotic was approximately 1.5-fold higher (p < 0.001) than laparoscopic for both procedures. For GB, laparoscopic had lower total ($15,520) and operative ($6497) average cost compared to open (total $17,779; operative $9273) and robotic (total $21,756; operative $10,896). For SG, laparoscopic total cost was significantly less than robotic ($10,691 vs. $16,393). Robotic GB cost-over-time increased until 2021, when there was a large decrease in cost (-$944, compared with 2020). Robotic SG total cost-over time fluctuated, but decreased significantly in 2021 (-$490 compared with 2020). While surgical costs rose significantly in 2020 for bariatric procedures, our study suggests a possible downward trend in robotic bariatric surgery as total and operative costs are decreasing at a higher rate than laparoscopic costs.

The use of preoperative planning to decrease costs and increase efficiency in the OR.

Background: Shoulder arthroplasty (SA) incurs up to $1.8B per year in societal costs. With the increasing demand for SA and the steady decrease of annual reimbursements for orthopedic procedures, it has become crucial to control costs. In SA, there has been an interest in using preoperative planning software to improve accuracy in positioning and implant selection, ultimately optimizing outcomes. However, the use of preoperative planning to increase efficiency has not been studied. The purpose of this study was to determine if preoperative planning could increase efficiency and decrease costs in the operating room. Methods: This retrospective review included 94 patients who underwent shoulder arthroplasty and had a CT scan with a preoperative plan by a single orthopedic surgeon between 2017 and 2020. The patients were divided based on the use of the preoperative plan during surgery. Group 1 included 65 patients with a preoperative plan used during surgery, and group 2 included 29 patients without a preoperative plan utilized during surgery. Average preparation time, surgical time, time in the operating room, the number of trays sterilized, and postoperative outcomes were analyzed between the two groups. Subanalysis was done to find a statistical difference in the cost of sterilization for both groups. Results: The cohort had 55% males, with an average age of 71 years and an average BMI of 29.9. There were no significant differences between the groups for age, BMI, or ASA class. There was no significant difference between groups in preparation time (group 1: 53.3 min, group 2: 53.1 min P = .924), surgical time (group 1: 119.7 min, group 2: 111.9 min; P = .25), or time in the OR (group 1: 183.2 min, group 2: 173.2 min; P = .156). There was a statistical difference in the number of trays (5 vs. 8; P < .01) and cost of sterilization between groups ($487.30 vs. $842.86; P < .01). No correlation between the number of trays and preparation time (group 1: -0.05, group 2: -0.28) or trays and surgical time was found for either group (group 1: r = -0.31, group 2: r = -0.22). There were no significant differences in postoperative outcomes between the groups. Conclusion: While preoperative planning did not reduce time in the OR for shoulder arthroplasty, it was correlated to a significant reduction in the number and cost of sterilized trays with comparable postoperative outcomes.

Pneumoretinopexy versus scleral buckling in retinal detachments with superior breaks: A comparative analysis of outcome and cost.

Purpose: The purpose of this study is to study single surgery reattachment rate, refractive shift, surgical time, cost, and complications of pneumoretinopexy (PR) compared to scleral buckling (SB) in rhegmatogenous retinal detachments (RRDs) with superior breaks. Methods: Data of RRD with superior breaks, from 2013 through 2016, treated either with PR or SB surgery at a tertiary eye-care center were retrospectively reviewed. Treatment outcomes, procedural costs, refractive shift, surgical time, and complications, namely, cataract and glaucoma, were analyzed. Results: Thirty-two cases treated by PR (n = 15) and SB surgery (n = 17) fulfilled the selection criteria. Macula off RRD (91%) was the commonest presentation. Baseline parameters like duration of vision loss, presenting vision, and ocular characteristics were comparable. Single surgery retinal reattachment (66.7% PR vs. 76.5% SB) was analogous (P = 0.698). Retinal reattachment with secondary intervention was achieved in all cases at the last follow-up. Average vision gain in logMAR of 0.8 in PR and 0.6 in SB was not significantly different (P = 0.645) between the two groups, with SB group having a 1.9 Dioptre myopic shift and PR group none. Surgical time was shorter in PR versus SB at 15 versus 85 min and surgical cost (including additional surgery) was 50% less in PR. Complications like cataract progression (P > 0.99) and glaucoma (P = 0.71) were analogous among the groups. Horse-shoe tears were associated with failed primary surgery in 60% of PR and 75% of SB procedures. Conclusion: In RRDs secondary to superior breaks, PR proved to be faster, more economical, and less tissue manipulative than scleral buckle surgery, with equivalent efficacy and safety profile.

Effect of Enhanced Recovery After Surgery Protocol Implementation on Cost and Outcomes by Type of Colectomy Performed.

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are widely utilized for elective colorectal surgery to improve outcomes and decrease costs, but few studies have evaluated the impact of ERAS protocols on cost with respect to anatomic site of resection. This study evaluated the impact of ERAS protocol on elective colon resections by site and longitudinal impact over time. METHODS: A single-center retrospective cohort study of 598 consecutive patients undergoing elective colorectal resection before and after implementation of ERAS protocol from 2013 to 2017 was performed. The primary outcomes were length of stay (LOS) and cost. Comparative and multivariate inferential statistics were used to assess additional outcomes. RESULTS: A total of 598 patients (100 pre-ERAS vs 498 post-ERAS) were evaluated with an overall median LOS of 4 days for right and left colectomies and 3 days for transverse colectomies. When comparing type of resection before and after ERAS protocol introduction, an increased LOS for left hemicolectomies from 3.09 to 4.03 days (P = .047) was noted, with all other comparisons failing to reach statistical significance. Over time, an initial decrease in LOS for MIS approach after protocol introduction was observed; however, this effect diminished in the ensuing years and had no significant effect overall. Total cost of care was significantly increased post-ERAS for all cohorts except transverse colectomies. No further statistically significant differences were found. CONCLUSION: After an initial improvement in outcomes, continued utilization of ERAS protocols demonstrated no improvement in LOS compared to pre-ERAS data and increased cost overall for patients regardless of site of resection.

The Hybrid Arch Bar Is a Cost-Beneficial Alternative in the Open Treatment of Mandibular Fractures.

Obtaining maxillomandibular fixation (MMF) to achieve fracture reduction and functional occlusion is essential in the management of maxillofacial trauma. The aims of this retrospective review were to compare the total time spent in the operating room (OR) when using the Erich arch bar (EAB) versus the bone anchored hybrid arch bar (HAB) as well as performing a cost-benefit analysis (CBA). The study sample comprised patients older than 18 years who underwent open reduction internal fixation of mandible fractures at two separate institutions over a 5-year period. The primary outcome variable was total surgical time in minutes, defined as the time from incision to the completion of closure. Average operative time was significantly longer for the EAB than for the HAB (186.74 ± 70.73 vs. 135.98 ± 2.69 minutes, p < 0.001). A significant amount of time was saved by using the HAB for unilateral (37.17 ± 13.19 minutes; p = 0.007) and bilateral fractures (55.83 ± 18.89 minutes; p = 0.005). In-depth CBA showed that, for average OR fees of $60 per minute, the HAB produced savings of at least 4.01 and 11.63% of the total cost of surgery for unilateral and bilateral fractures. These results support the hypothesis that the HAB is a time-saving maneuver in the open treatment of mandible fractures. The HAB saves more time in bilateral fracture cases despite the longer overall operative times. This study shows the differential time-saving effect of the HAB regardless of fracture laterality as well as its cost minimization benefit compared with the EAB.

Effect of CYP3A5 genotype on hospitalization cost for kidney transplantation.

Background Dosage quantities of tacrolimus (TAC) vary according to cytochrome P450 3A5 (CYP3A5) genotype. Genotyping is expected to optimize the response to TAC response and to minimize adverse effects. In Thailand, kidney transplantation is reimbursable with the same diagnosis-related group payment regardless of patient's CYP3A5 genotype. Objective This study aimed to determine the costs of TAC administration, therapeutic drug monitoring (TDM), and hospitalization for kidney transplantation across CYP3A5*1/*1, *1/*3, and *3/*3 genotypes. Setting A single transplant center in a university hospital. Method This is an observational study that collected data from patients pooled from both arms of a randomized controlled trial that tested initial doses of TAC. Main outcome measure TAC and TDM cost and hospitalization cost for transplantation were compared between genotypes. Results The CYP3A5*1/*1 patients had the highest median combined TAC-TDM cost and hospitalization cost ($1062 and $9097), followed by CYP3A5*1/*3 ($859 and $6467) and CYP3A5*3/*3 patients ($761 and $5604). The CYP3A5*1/*1 patients had a higher hospitalization cost by $2787 over the CYP3A5*1/*3 patients, despite marginal significance. The CYP3A5*1/*1 patients had a significantly higher cost of TAC plus TDM (by $309) and hospitalization cost (by $3275) than the CYP3A5*3/*3 patients. Both study costs were significantly higher in patients with delayed graft functioning than in patients with instant or slow graft functioning. Conclusion The benefits of genotype detection in patients with CYP3A5*1/*1 should be considered for a higher reimbursement rate because of the substantial differences in total hospitalization cost for kidney transplantation among patients with different CYP3A5 genotypes.

Operating room waste: disposable supply utilization in neurosurgical procedures.

OBJECTIVE Disposable supplies constitute a large portion of operating room (OR) costs and are often left over at the end of a surgical case. Despite financial and environmental implications of such waste, there has been little evaluation of OR supply utilization. The goal of this study was to quantify the utilization of disposable supplies and the costs associated with opened but unused items (i.e., "waste") in neurosurgical procedures. METHODS Every disposable supply that was unused at the end of surgery was quantified through direct observation of 58 neurosurgical cases at the University of California, San Francisco, in August 2015. Item costs (in US dollars) were determined from the authors' supply catalog, and statistical analyses were performed. RESULTS Across 58 procedures (36 cranial, 22 spinal), the average cost of unused supplies was $653 (range $89-$3640, median $448, interquartile range $230-$810), or 13.1% of total surgical supply cost. Univariate analyses revealed that case type (cranial versus spinal), case category (vascular, tumor, functional, instrumented, and noninstrumented spine), and surgeon were important predictors of the percentage of unused surgical supply cost. Case length and years of surgical training did not affect the percentage of unused supply cost. Accounting for the different case distribution in the 58 selected cases, the authors estimate approximately $968 of OR waste per case, $242,968 per month, and $2.9 million per year, for their neurosurgical department. CONCLUSIONS This study shows a large variation and significant magnitude of OR waste in neurosurgical procedures. At the authors' institution, they recommend price transparency, education about OR waste to surgeons and nurses, preference card reviews, and clarification of supplies that should be opened versus available as needed to reduce waste.

Pancreaticoduodenectomy hospital resource utilization in octogenarians.

BACKGROUND: Although pancreaticoduodenectomy (PD) is feasible in patients greater than or equal to 80 years, little is known about the potential strain on resource utilization. METHODS: Outcomes and inpatient charges were compared across age cohorts (I: ≤70, II: 71 to 79, III: ≥80 years) in 99 patients who underwent PD (2005 to 2013) at our institution. The generalized linear modeling approach was used to estimate the impact of age. RESULTS: Perioperative complications were equivalent among cohorts. Increasing age was associated with intensive care unit use, increased length of stay (LOS), and the likelihood of discharge to a skilled facility. After controlling for covariates, hospital charges were significantly higher in Cohort III (P = .006) and Cohort II (P = .035) when compared with Cohort I. However, hospital charges between Cohorts II and III were equivalent (P = .374). Complications (P = .005) and LOS (P < .001) were associated with higher hospital charges. CONCLUSIONS: Increasing age was associated with increased intensive care unit, LOS, and discharge to skilled facilities. However, octogenarians had equivalent PD charges and outcome measures when compared with septuagenarians and future studies should validate these findings in larger national studies.