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

Ann Surg. 2021 Jul 1;274(1):107-113. doi: 10.1097/SLA.0000000000003571.


Objective: The aim of this study was to understand variation in intraoperative and postoperative utilization for common general surgery procedures.

Summary background data: Reducing surgical costs is paramount to the viability of hospitals.

Methods: Retrospective analysis of electronic health record data for 7762 operations from 2 health systems. Adult patients undergoing laparoscopic cholecystectomy, appendectomy, and inguinal/femoral hernia repair between November 1, 2013 and November 30, 2017 were reviewed for 3 utilization measures: intraoperative disposable supply costs, procedure time, and postoperative length of stay (LOS). Crossed hierarchical regression models were fit to understand case-mixed adjusted variation in utilization across surgeons and locations and to rank surgeons.

Results: The number of surgeons performing each type of operation ranged from 20 to 63. The variation explained by surgeons ranged from 8.9% to 38.2% for supply costs, from 15.1% to 54.6% for procedure time, and from 1.3% to 7.0% for postoperative LOS. The variation explained by location ranged from 12.1% to 26.3% for supply costs, from 0.2% to 2.5% for procedure time, and from 0.0% to 31.8% for postoperative LOS. There was a positive correlation (ρ = 0.49, P = 0.03) between surgeons' higher supply costs and longer procedure times for hernia repair, but there was no correlation between other utilization measures for hernia repair and no correlation between any of the utilization measures for laparoscopic appendectomy or cholecystectomy.

Conclusions: Surgeons are significant drivers of variation in surgical supply costs and procedure time, but much less so for postoperative LOS. Intraoperative and postoperative utilization profiles can be generated for individual surgeons and may be an important tool for reducing surgical costs.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Appendectomy / economics
  • California
  • Cholecystectomy, Laparoscopic / economics
  • Cost Control
  • Equipment and Supplies, Hospital / economics
  • Female
  • Herniorrhaphy / economics
  • Hospital Costs*
  • Humans
  • Intraoperative Care / economics*
  • Laparoscopy / economics
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Operative Time
  • Postoperative Care / economics*
  • Retrospective Studies
  • Surgical Procedures, Operative / economics*