C. P. Childers1,2, B. Zhao3, J. Tseng4, R. F. Alban4, B. M. Clary3, M. Maggard-Gibbons1 1University Of California – Los Angeles,Surgery,Los Angeles, CA, USA 2University Of California – Los Angeles,Fielding School Of Public Health, Department Of Health Policy & Management,Los Angeles, CA, USA 3University Of California – San Diego,Surgery,San Diego, CA, USA 4Cedars-Sinai Medical Center,Surgery,Los Angeles, CA, USA
Introduction:
New surgical instruments are often proposed to improve operative efficiency, but at added cost. The marginal savings from reducing operative time are small, with previous estimates well under $10/minute. If surgeons overestimate the value of operative efficiency they may choose instruments which add unnecessary costs to the system.
Methods:
A web-based survey was distributed to 100 attending general and subspecialist (eg, colorectal) surgeons at 3 academic health systems. The outcome was the surgeon’s opinion of the marginal cost of one minute of operating room (OR) time, asked through a willingness to pay framework (Figure). Multivariable models were fit to assess factors associated with mean or outlier (top quintile) values. Covariates included institution, gender, fellowship, years after training, specialty, and, for a small subset (n=35), publicized salary information.
Results:
The overall response rate was 83% (83/100) with 75 surgeons providing numeric and reasonable (i.e. ≥ $0) estimates for the marginal cost of OR time. Mean (SD) and median (IQR) values were $28.53 ($27.92) and $21.43 ($7.14-$35.71). Thirteen (17.3%) responses were ≥$40 (top quintile). None of the studied covariates were associated with mean or outlier estimates except that surgeons at one institution had consistently higher estimates than those from the other two. There was no association between marginal cost and surgeon salary.
Conclusion:
On average, surgeons believed it was reasonable for hospitals to spend $20-30 to save one minute in the OR – values likely much larger than the actual money saved. The wide variability in estimates, along with the absence of a significant predictor, may suggest a relative lack of education on the topic. These findings suggest financial education may be necessary to enable surgeons to make the best value decisions in the OR.
