Surgeon Variability Impacts Costs in Laparoscopic Cholecystectomy: the Volume-Cost Relationship.

Journal Article (Journal Article)

BACKGROUND: Physician variation in adherence to best practices contributes to the high costs of health care. Understanding surgeon-specific cost variation in common surgical procedures may inform strategies to improve the value of surgical care. METHODS: Laparoscopic cholecystectomies at a single institution were identified over a 5-year period and linked to an institutional cost database. Multiple linear regression was used to control for patient-, case-, and hospital-specific factors while assessing the impact of surgeon variability on cost. RESULTS: The final dataset contained 1686 patients. Higher surgeon volume (reported in tertiles) was associated with decreased costs ($5354 vs. $6301 vs. $7156, p < 0.01) and OR times (66 min vs. 85 min vs. 95 min, p < 0.01). After controlling for patient-, case-, and hospital-specific factors, non-MIS fellowship training type (p < 0.01) and low surgeon volume (p < 0.01) were associated with increased costs, while time in practice did not contribute to cost variation (p = NS). CONCLUSIONS: Surgeon variability contributes to costs in laparoscopic cholecystectomy. Some of this variability is associated with operative volume and fellowship training. Collaboration to limit this cost variability may reduce surgical resource utilization.

Full Text

Duke Authors

Cited Authors

  • Stahl, CC; Udani, S; Schwartz, PB; Aiken, T; Acher, AW; Barrett, JR; Greenberg, JA; Abbott, DE

Published Date

  • January 2021

Published In

Volume / Issue

  • 25 / 1

Start / End Page

  • 195 - 200

PubMed ID

  • 33037553

Pubmed Central ID

  • PMC7855565

Electronic International Standard Serial Number (EISSN)

  • 1873-4626

Digital Object Identifier (DOI)

  • 10.1007/s11605-020-04814-0


  • eng

Conference Location

  • United States