MAXIMIZING THE COST EFFECTIVENESS OFROBOTIC-ASSISTED SACROCOLPOPEXY THROUGH OPERATING ROOM COSTCONTAINMENT INITIATIVES
A. HARRISON 1, J. TURCOTTE2, Y. ZHENG 1, K. A. HOSKEY 1, B.WALTON1;
1Anne Arundel Med. Ctr.,Annapolis, MD, 2Surgery, Anne Arundel Med. Ctr.,Annapolis, MD.
Introduction: Approximately200,000 women in the United States undergo pelvic organ prolapse(POP) surgery annually . Robotic-assisted sacrocolpopexy (SCP) isa common surgical intervention used to treat advanced POP. Surgicalsuccess is commonly evaluated by the Pelvic Organ ProlapseQuantification (POP-Q) measurement . In the current resourceconstrained healthcare environment, it is essential that the costeffectiveness of surgical procedures be measured and maximized toensure efficient allocation of resources. However, there is littleresearch describing how cost-saving methods in the operating room(OR) affect surgical outcomes of pelvic organ prolapsesurgery.
Objective: Our objective was to measure the impactof cost-savings initiatives in the OR and to determine whether theseinitiatives affect postoperative outcomes of robotic assisted SCP inorder to establish guidelines for enhancing the cost effectiveness ofthe procedure.
Methods: A retrospective review of 295consecutive patients undergoing robotic-assisted SCP between June2013 and May 2016, performed by 3 surgeons at a regional medicalcenter was conducted. Preoperative patient characteristics includingAmerican Society of Anesthesiologists (ASA) score, HierarchicalCondition Category (HCC) score, and patient age were captured.Financial and clinical outcomes were assessed by year. Postoperativeoutcomes included length of stay, 30 day readmission/revisit, POP-Qchanges from pre-op to 6 months post-op, POP-Q changes from pre-op to1 year post-op, surgical success or failure, operating room supplyand implant cost, and total hospital cost of the episode of care.Surgical failure was determined using multiple methodologies: apositive POP-Q cervix measurement, or a cervix measurement > [-2/3x total vaginal length] as described by Barber et al. in the OptimalTrial [2,3]. Hospitalization costs were extracted from hospital costaccounting systems and statistical analysis was conducted using SPSS(IBM version 23).
Results: Across the patient cohort, theaverage total hospitalization cost and OR supply and implant costdecreased over the 4 year study. Total hospitalization cost decreasedfrom $12245 in 2013 to $9815 in 2016 (p <0.001), while the averageOR supply and implant cost decreased from $4791 in 2013 to $3789 in2016 (p<.001). Over the time period, surgeries performed with theconcomitant insertion of a urethral sling were significantly morecostly than those without (total average hospitalization cost of$12995 vs. $10842, p<.001; and average OR supply and implant costof $4392 vs. $3713, p<.001). No significant differences were foundin preoperative surgical risk factors as measured by ASA score (totalaverage = 2.88, p=.388) or patient age (total average = 61.2,p=.997). Medical risk, as measured by the CMS HCC score was alsoconsistent over the time period (p=.220). Average procedure durationand average length of stay (ALOS) both displayed significantdecreases from 2013 to 2016, with inpatient ALOS decreasing from 1.1days to 0 days in 2016 (p<0.001), and average procedure durationdecreasing from 217.3 minutes to 205.9 minutes (p=.019). Averagechange in POP-Q cervix measurement from pre-op to 6 months post-opremained consistent (total average = -2.2 cm, p=.403) while theaverage change in cervix measurement from pre-op to 1 year post-opdisplayed a significant decrease from -5.76 cm in 2013 to -1.44 cm in2015 (p<.001). All postoperative outcomes measuring overalloperative success remained consistent over the period underexamination. No significant change was observed in 30 day readmissionor ED revisit rate (total average = 2.4%, p=.213), 6 month successrate, defined as the presence of a negative cervix measurement (totalaverage = 99.3%, p =.650), 1 year success rate defined as thepresence of a negative cervix measurement (total average = 99.2%, p=.207), and 1 year success defined as a cervix measurement > [-2/3x total vaginal length] (total average = 99.2%, p=.210).
Conclusions:The implementation of various cost savings initiatives over a fouryear period resulted in decreased OR and hospitalization costswithout diminishing the quality of surgical outcome for patientsundergoing robotic-assisted sacrocolpopexy and present an opportunityto enhance the cost-effectiveness of the procedure.
References:1.Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapsein the United States, 1979-1997. Am J Obstet Gynecol.2003;188(1):108-15. 2. Nygaard I, Brubaker L, Zyczynski HM, et al.Long-term outcomes following abdominal sacrocolpopexy for pelvicorgan prolapse. JAMA. 2013;309(19):2016-24. 3. Barber MD, Brubaker L,Burgio KL, et al. Comparison of 2 transvaginal surgical approachesand perioperative behavioral therapy for apical vaginal prolapse: theOPTIMAL randomized trial. JAMA. 2014;311(10):1023-34.