The relationship between quality and costs: factors that affect the hospital costs of radical prostatectomy

Abstract

The present study seeks to establish a relationship between the quality of a surgical procedure and the subsequent hospital costs for that procedure by investigating the influence of both patient and peri-operative factors on the hospital costs of radical prostatectomy. All men who underwent radical prostatectomy at one institution during an 18-month period were included in this study. Clinical information was obtained from medical records and cost information was obtained from hospital billing data. The medical record was also used to determine peri-operative information such as operating room time, anesthesia time, surgical time, blood loss and units of packed red blood cells transfused. The correlation between costs and both clinical and peri-operative factors were determined using the Pearson correlation co-efficient. One hundred and four men underwent radical prostatectomy at our institution during the time period studied. Mean age of these patients was 60.2 y and mean length of stay for these patients was 3.4 days with a range of 2 -10 days. Mean total hospital costs for this cohort was $5305 with a range of $2851 -$10 358. Significant correlations with total hospital costs included operating room time, surgical time, estimated blood loss and blood transfused. Patient factors such as age, ASA class, co-morbidities and smoking history were not correlated with total hospital costs. The present study demonstrates that factors at least partially controlled by the surgeon such as surgical time and units of blood transfused directly influence the total hospital costs of radical prostatectomy, while patient factors such as age and the presence of co-morbidities had no significant correlation with total hospital costs. These findings demonstrate that surgeons can impact health care costs by providing high quality care and begins to establish a relationship between high quality care and low cost care. Prostate Cancer and Prostatic Diseases (2001) 4, 213-216.

Costs of radical cystectomy

“…The same finding, but for radical prostatectomy, was reported by Benoit and Cohen [15]. These authors found that operating time, estimated blood loss and amount of transfused blood correlated with total hospital costs.…”

Comparison of autograft versus allograft in the surgical repair of pediatric obstetrical brachial plexus injuries

“…In contrast, increased surgical time has been correlated to increased anesthesia, increased blood loss, and increased length of stay (and consequently increased costs incurred for the patient and the hospital). 24,25 In our study, operative time was reduced by more than 30 minutes through the use of ALG as compared to the extra harvest time for AUG and would seem to add further justification for ALG use in these patients, although this savings may be partially offset by the cost and storage of the ALG.…”

Variation in Intraoperative and Postoperative Utilization for 3 Common General Surgery Procedures

“…For example, if surgeons only explain a small percentage of the variation in supply costs, then efforts targeting surgeons will have limited effect. A handful of studies have attempted to understand variation in supply costs, [4][5][6][7][8][9][10][11][12][13] but most have focused on a single operation at a single health system and have used limited methods for understanding variation. The inclusion of only one health system is especially limiting as institutional policies and practices may contribute substantially to cost variation.…”