Category: Epidemiology, Health Policy, Socioeconomics & Outcomes
Introduction & Objective :
As value-based health care gains favor and reimbursement models move toward quality rather than quantity of care, a better understanding of cost and its predictors becomes increasingly important. We aim to identify how preoperative characteristics, intraoperative variables, and postoperative complications of impact cost of partial nephrectomy.
After IRB approval, we accessed our institution’s National Surgical Quality Improvement Program (NSQIP) database using CPT codes for minimally-invasive partial nephrectomies (MIPN)performed from January 2012 to March 2017. Perioperative and financial data were collected and studied. Total cost (TC) and direct cost (DC) were analyzed relative to clinical variables.
Two hundred fifteen patients underwent MIPN during this time period. Median total cost (TC) was $17,000 (IQR $14,100-$19,200), and median direct cost (DC) was $11,500 (IQR $9,600-$13,000). Among preoperative characteristics, age 56-65 and diabetes were associated with an increased median DC of $2,000 and $800 respectively (p<0.05). ASA class III was associated with increased DC of $1,400 compared to ASA class I-II (p<0.01). Among intraoperative variables, increasing operative duration was associated with increasing DC (p<0.001). Robot-assisted cases had increased DC by $3,000 when compared to hand assisted (p<0.001). Estimated blood loss (EBL) over 250cc was associated with an increased DC of $800 (p<0.01). R.E.N.A.L. score did not affect cost parameters. Patients experiencing any postoperative complications were found to have increased direct cost compared to those who did not (p<0.01). Blood transfusions were associated with increased DC of $3,700 and unplanned reintubation of $14,500 (p<0.05). SeeTable 1 and Figure 1.
Age, diabetes, ASA class, operative duration, EBL, robot use, and post-operative complications were associated with increased cost of MIPN. Increased understanding of cost predictors can be used to optimize perioperative care and value, as well as contribute to improved alternative reimbursement models.
University of Kentucky
My name is Andrew M. Harris, MD and I'm currently the endourology and robotics fellow at the University of Kentucky. I finished my residency training at the University of Pennsylvania in 2012 followed by a brief period in private practice prior to matriculation to fellowship. My reserach efforts focus on health care economics/cost/safety/qi/lean implementation/resident education and am currently in classes to receive a certificate in improving health care value with an emphasis in safety and quality improvement.