Operative time and cost variability for functional endoscopic sinus surgery

Thomas, Andrew J.; Smith, Kristine A.; Newberry, Christopher Ian; Cardon, Brandon; Davis, Brock; Ou, Zhining; Presson, Angela P.; Alt, Jeremiah A.

doi:10.1002/alr.22198

Cited by 16 publications

(11 citation statements)

References 22 publications

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“…Furthermore, supply costs have been shown to vary with extent of surgery, ranging from $462 for anterior ESS to $1234 for full ESS. 9 Procedure type was similarly shown to be significantly associated with supply cost in the current study (p = 0.02). In this context, overall surgical supply cost values must be interpreted with extent of surgery in mind.…”

Section: Discussionsupporting

confidence: 61%

Surgeon cost feedback through a surgical receipt program reduces cost in sinonasal surgery

Gill

Reddy

Kulinich

et al. 2020

Int Forum Allergy Rhinol

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Background Operating room (OR) costs are a large portion of healthcare expenses. This study evaluates the impact of a surgeon‐targeted surgical receipt cost feedback system on OR supply costs in sinonasal surgery and individual components contributing to procedural cost. Methods Itemized weekly surgical receipts detailing individual case supply costs were analyzed before and after the implementation of a non‐incentivized surgeon cost feedback system between January 2017 and June 2019. Supply cost data collected 15 months prior to intervention was compared to cost data 15 months after implementation of the weekly automated receipt dissemination to surgeons. Chi square test was used for categorical data and the Wilcoxon test was used to compare change in cost. Univariate and mediation analyses were performed to assess variables impacting cost. Results Of 502 sinonasal procedures analyzed, 239 were before and 264 after cost feedback implementation. There were no significant differences in age/gender, or indication for surgery. The median OR supply cost decreased from $1229.64 to $1097.22 (p = 0.02) after receipt implementation. There were effects of procedure type (p = 0.02), circulating nurse specialization (p < 0.001), steroid eluting stent (p = 0.002), and sinus drill (p < 0.001) on cost. Mediation analysis confirmed full mediation by decreasing use of steroid‐eluting stents. Conclusion Surgeon cost feedback in the form of individualized OR surgical receipts is an effective model to reduce supply cost per case in sinonasal surgery.

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Section: Discussionsupporting

confidence: 61%

Surgeon cost feedback through a surgical receipt program reduces cost in sinonasal surgery

Gill

Reddy

Kulinich

et al. 2020

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

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“…The resolution of this procedure‐specific accounting of ESS expands upon a recent analysis of cost and time variance for 3 common combinations of bilateral ESS in the same multihospital network 8 . Facility type of the surgery was identified in this prior study as a source of variance in time and costs 8 . The multihospital network where these studies were performed includes facilities ranging from community rural to tertiary urban hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…Other patient and surgical details, such as sex, age (pediatric <18, or adult ≥18 years old), concha bullosa resection, revision case, and image guidance use, were controlled for in the data analysis. Effects of additional commonly performed procedures of septoplasty and/or turbinate reduction were included, and their predicted impact on the outcome variables of time and costs has been described in an earlier study 8 . Distribution was assessed for each variable, both visually using scatterplots and mathematically using normality tests.…”

Section: Methodsmentioning

confidence: 99%

“…Not surprisingly, reported costs of ESS range widely from approximately $3600, 6,7 to over $10,500 in 2016 US dollars (USD) 7 . In a single study resolving ESS into 3 common groups of ESS procedures, cost and operative time increased with surgical extent 8 . This preliminary evidence suggests the importance of understanding costs of all ESS procedure combinations, in order to make appropriate economic and value‐oriented decisions.…”

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confidence: 99%

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Cost and operative time estimation itemized by component procedures of endoscopic sinus surgery

Thomas

McCoul

Newberry

et al. 2020

Int Forum Allergy Rhinol

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Background: Endoscopic sinus surgery (ESS) is a variable combination of individual procedures. Cost estimates for ESS as a single entity have wide variation, likely influenced by variation in procedures performed. We sought to identify operative time, supply costs, and total procedure cost specific to the component procedure combinations comprising ESS. Methods:Bilateral ESS cases at 13 Intermountain Healthcare facilities (2008 to 2016) were identified from a database with corresponding cost and time data. Procedure details were obtained by chart review. Least-squares (LS) means of cost (in 2016 US dollars) and time for specific procedures were obtained by multivariable gamma regression models.Results: Among 1477 bilateral ESS cases with 19 different procedure combinations, operative time ranged from 59.5 (95% confidence interval [CI], 48.6-73.0) minutes for total ethmoid to 147.1 (95% CI, 126.4-171.2) minutes for full ESS with maxillary and sphenoid tissue removal. Sphenoidotomy had lowest total and supply costs

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“…When this is taken into account, median true cost of intermediate-to-full FESS ranges between $3716 and $4 281, a substantially lower figure than those cited in other studies. 42 These dramatic variations in figures cited would have large effects on cost-effectiveness models, and should be interpreted accordingly.…”

Section: Costs Of Aerd Treatmentsmentioning

confidence: 99%

Biologic therapies versus surgical management for aspirin‐exacerbated respiratory disease: A review of preliminary data, efficacy, and cost

Workman

Bleier

2020

World j. otorhinolaryngol.-head neck surg.

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Aspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surgery for recalcitrant disease. Given this severity, anti-type 2 biologic treatments are being investigated for use in this subgroup of patients with CRSwNP, including Omalizumab and Dupilumab. Preliminary data suggests that SNOT-22 related quality of life improvements following treatment with biologics are comparable to the current standard of care in the short term, but there is a lack of long-term data and standardized regimen that makes direct comparison difficult. Biologic therapies additionally require continuous use to avoid recurrence, and currently cost many times more than existing medical or surgical therapies.

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Operative time and cost variability for functional endoscopic sinus surgery

Abstract: Duration of surgery, extent of surgery, and location of surgery are sources of significant variation in the cost of ESS. These findings will assist healthcare policy makers, hospitals, and surgeons in optimizing the value of ESS.

Cited by 16 publications

References 22 publications

Surgeon cost feedback through a surgical receipt program reduces cost in sinonasal surgery

Surgeon cost feedback through a surgical receipt program reduces cost in sinonasal surgery

Cost and operative time estimation itemized by component procedures of endoscopic sinus surgery

Biologic therapies versus surgical management for aspirin‐exacerbated respiratory disease: A review of preliminary data, efficacy, and cost

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