Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis

Saporito, Andrea; Regina, Davide La; Perren, Andréas; Gabutti, Luca; Anselmi, Luciano; Cafarotti, Stefano; Mongelli, Francesco

doi:10.1016/j.bjane.2021.03.024

Cited by 2 publications

(4 citation statements)

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“…The cost calculation we performed was based on the Swiss-DRG ( 30 ). Different DRG systems share the same concept and have many similarities ( 31 ). Moreover, several articles described that DRG systems in Europe and United States are comparable in terms of cost calculation and DRG-based reimbursement.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, several articles described that DRG systems in Europe and United States are comparable in terms of cost calculation and DRG-based reimbursement. Although cost values vary among countries, economic analyses are applicable to countries adopting DRG systems ( 30 , 31 , 40 ).…”

Section: Discussionmentioning

confidence: 99%

“…Thereafter, a micr-costing technique was applied, which consisted of excluding costs of consumables not directly or indirectly related to transfusions. Costs were reported in United States dollar (USD) and included all direct and variable costs, such as the cost of RBC units, inventory management, transport and other processing fees, costs of transfusion-related complications, unexpected readmission after discharge, and proportional fix cost allocations (how indirect costs are distributed across equipment and divisions) ( 31 ). In case of death, costs were calculated as described above.…”

Section: Methodsmentioning

confidence: 99%

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Perioperative inappropriate red blood cell transfusions significantly increase total costs in elective surgical patients, representing an important economic burden for hospitals

et al. 2022

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BackgroundRed blood cell (RBC) transfusions in surgical patients are associated with increased morbidity a hospital stay. However, little is known about how clinical and economic outcomes differ between appropriately and inappropriately transfused patients. We hypothesized that inappropriate RBC transfusions in elective surgical patients would significantly increase hospital cost. The aim of this study was to quantify the economic burden associated with inappropriate RBC transfusions.MethodsWe retrospectively included all adult patients admitted for elective non-cardiac surgery between January 2014 and March 2020. Patients were divided into three groups (not transfused, appropriately transfused and inappropriately transfused). The primary outcome was the excess in hospital cost in patients inappropriately transfused compared to non-transfused patients. Costs were calculated using a bottom–up approach and involving cost calculation on a granular level. According to international guidelines, transfusions were considered appropriate if administered with an ASA score of 1–2 and the last hemoglobin level measured before transfusion < 70 g/L, or with an ASA score ≥ 3 and the last hemoglobin level < 80 g/L. Cases where RBC transfusions were deemed necessary regardless of the Hb levels were reviewed by the patient blood management (PBM) board and classified accordingly. Secondary outcomes included total transfusion rate, transfusion index, and length of hospital stay. Statistical analysis was carried out by multivariable regression models.ResultsDuring the study period there were 54,922 consecutive surgical admissions, of these 1,997 received an RBC transfusion, with 1,125 considered inappropriate. The adjusted cost of each inappropriate RBC transfusions was estimated in United States dollars (USD) 9,779 (95% CI, 9,358 – 10,199; p < 0.001) and totaled USD 11,001,410 in our series. Inappropriately transfused patients stayed 1.6 times (95% CI, 1.5–1.6; p < 0.001) longer in hospital (10.6 days vs. 6.7 days) than non-transfused patients and a mean 2.35 RBC units per patient were administered.ConclusionInappropriate RBC transfusions in elective surgical patients seem to be common and may represent a significant economic burden. In our experience, inappropriate transfusions significantly increased hospital costs by an average of USD 9,779 compared to non-transfused patients. Through specific PBM policy, hospitals may improve cost-effectiveness of their elective surgical activity by lowering inappropriate transfusions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Perioperative inappropriate red blood cell transfusions significantly increase total costs in elective surgical patients, representing an important economic burden for hospitals

et al. 2022

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“…Services that experience high demand for surgeries should take into account in their strategic planning the need to attract procedures that generate higher profits. It is important to be cautious when investing in procedures with high expected contribution margins, such as complex surgeries, as their hourly profitability may turn out to be low if either they take longer than expected or if their length of stay is longer than predicted, as evidenced by Saporito et al 1 Anesthesiology groups should also consider this idea, as investing in performing low-complexity procedures can sometimes be more profitable than investing in high-complexity procedures. Low-complexity procedures typically exhibit consistent demand and shorter durations, thus yielding a high hourly profitability.…”

Section: Operating Room Managementmentioning

confidence: 99%