Bariatric surgery: disposable costs are driven by surgeon variability without measurable benefit.

BACKGROUND

Sixty percent of hospital expenses arise from operating room costs. We hypothesize there are considerable cost inefficiencies due to surgeon variability.

OBJECTIVES

To model the association between variability in disposable operative costs and patient outcomes in a high-volume bariatric surgery service line.

SETTING

Large University Health care System.

METHODS

Mixed-effects regression models assessed the association between disposable operating costs and robotic use, procedure type, patient factors, and surgeon effects. We also modeled whether increased costs translated to improved operative time (OT), prolonged length of stay (pLOS), readmissions, or reoperations.

RESULTS

We studied 4067 gastric sleeve (SG) (34% robotic), 1375 gastric bypass (RYGB) (33% robotic), and 447 duodenal switch (BPD/DS) (68% robotic) procedures. Average model adjusted costs for laparoscopic and robotic cases: SG $3592 ± 28 and $4451 ± 3; for RYGB was $5370 ± 40 for $5457 ± 64; and for BPD/DS $3780 ± 53 $6367 ± 47; all respectively. Surgeon variability increased costs by up to ±59.4%. The model-adjusted difference in cost between the far outlier surgeons spanned $1827 for the SG, $2678 for the RYGB, and $3305 for the BPD/DS. The use of robotic platforms did not significantly affect readmission or reoperation rates. Higher costs were linked to longer OT (P < .001) and increased pLOS (P = .02). The surgeon had the most significant impact on cost compared to any other variable. Based on the least costly surgeons' costs (by platform and procedure), 25.4% of operative expenses are without measurable benefit.

CONCLUSIONS

Substantial surgeon-driven variability in disposable costs does not correlate with improved clinical outcomes, highlighting opportunities for value optimization.