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Operating room cost

David H Rothstein, Mehul V Raval
The operating room is the financial hub of any hospital, and maximizing operating room efficiency has important implications for cost savings, patient satisfaction, and medical team morale. Over the past decade, manufacturing principles and processes such as Lean and Six Sigma have been applied to various aspects of healthcare including the operating room. Although time consuming, process mapping and deep examinations of each step of the patient journey from pre-operative visit to post-operative discharge can have multiplicative benefits that extend from cost savings to maintaining the focus on improving quality and patient safety...
April 2018: Seminars in Pediatric Surgery
Narjeet S Khurmi, Yu-Hui Chang, D Eric Steidley, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Amit K Mathur
BACKGROUND: Cardiovascular disease (CVD) is a leading cause of post-liver transplant death, and variable care patterns may affect outcomes. We aimed to describe epidemiology and outcomes of inpatient CVD care across U.S. hospitals. METHODS: Using a merged dataset from the 2002-2011 Nationwide Inpatient Sample and the American Hospital Association Annual Survey, we evaluated liver transplant patients admitted primarily with myocardial infarction (MI), stroke (CVA), congestive heart failure (CHF), dysrhythmias, cardiac arrest (CA), or malignant hypertension...
March 15, 2018: Liver Transplantation
Duong Tung Pham, Joseph Paul Baboo, Jinju Song, Sungjin Kim, Jeonggeun Jo, Vinod Mathew, Muhammad Hilmy Alfaruqi, Balaji Sambandam, Jaekook Kim
Pyrite (FeS2 ) is a promising electrode material for lithium ion batteries (LIBs) because of its high natural availability, low toxicity, cost-effectiveness, high theoretical capacity (894 mA h g-1 ) and high theoretical specific energy density (1270 W h kg-1 , 4e- /FeS2 ). Nevertheless, the use of FeS2 in electrochemical capacitors was restricted due to fast capacity fading as a result of polysulfide (S/Sn 2- ) formation during the initial electrochemical cycling. In order to avoid the formation of polysulfides, we employed the strategy of utilizing an ether based electrolyte (1...
March 15, 2018: Nanoscale
D A Friedlander, W W Ludwig, J R Jayman, A Akhavan
INTRODUCTION: Endoscopic injection of a bulking agent is a common first-line approach to the treatment of vesicoureteral reflux (VUR). While early outcomes are comparable to open ureteroneocystotomy, 5-25% of children will eventually develop recurrent reflux necessitating repeat injections or open ureteral reimplantation. OBJECTIVE: To determine whether prior endoscopic injection of a bulking agent impacts outcomes of subsequent open ureteral reimplantation. STUDY DESIGN: Using a retrospective cohort design, radiographic and clinical outcomes of open ureteral reimplantation were compared between patients with and without prior endoscopic correction of reflux...
March 1, 2018: Journal of Pediatric Urology
Samantha Tayne, Christian A Merrill, Rajeev C Saxena, Caitlin King, Karthik Devarajan, Stefan Ianchulev, Jon Chilingerian
Given the rising costs of healthcare delivery and reimbursement constraints, large academic medical centers (AMCs) must improve efficiency while delivering high-quality care. With standardized cases and high volumes, ambulatory surgery is a high-value target for efficiency improvement. Mining a data set of more than 7,500 cases consisting of the three highest-volume ambulatory procedures in orthopedics, otolaryngology-head and neck surgery, and urology, we analyzed process times and wait times involved in patient flow...
March 2018: Journal of Healthcare Management / American College of Healthcare Executives
Christopher P Childers, Amy Showen, Teryl Nuckols, Melinda Maggard-Gibbons
OBJECTIVE: The aim of this study was to systematically review the risks and benefits of interventions designed to reduce intraoperative costs. SUMMARY BACKGROUND DATA: Episode-based payments shift financial risk from insurers onto hospitals and providers. The operating room (OR) is a resource dense environment and there is growing interest in identifying ways to reduce intraoperative costs while maintaining patient safety. METHODS: We searched PubMed, Cochrane, and CINAHL for articles published between 2001 and March 2017 that assessed interventions designed to reduce intraoperative costs...
March 12, 2018: Annals of Surgery
Briony K Varda, Ye Wang, Benjamin I Chung, Richard S Lee, Michael P Kurtz, Caleb P Nelson, Steven L Chang
INTRODUCTION: Since 2010, there have been few new data comparing perioperative outcomes and cost between open (OP) and robotic pyeloplasty (RP). In a post-adoption era, the value of RP may be converging with that of OP. OBJECTIVE: To 1) characterize national trends in pyeloplasty utilization through 2015, 2) compare adjusted outcomes and median costs between OP and RP, and 3) determine the primary cost drivers for each procedure. STUDY DESIGN: We performed a retrospective cohort study using the Premier database, which provides a nationally representative sample of U...
February 22, 2018: Journal of Pediatric Urology
Julio T Chong, Kathleen M Kan, Courtney K Phillips, Alexander Greenstein
Purpose: Placement of pre-operative ureteral catheters for colorectal surgery can aid in the identification of ureteral injuries. This study investigates whether simultaneous ureteral catheterization with surgery skin preparation can minimize operating room times without increasing post-operative complications. Materials and Methods: Patients undergoing simultaneous colorectal surgery skin preparation and placement of pre-operative ureteral catheters (n=21) were compared to those who underwent these events sequentially (n=28)...
March 2018: Investigative and Clinical Urology
Yaqin Fu, Ying-Bing Jiang, Darren Dunphy, Haifeng Xiong, Eric Coker, Stan Chou, Hongxia Zhang, Juan M Vanegas, Jonas G Croissant, Joseph L Cecchi, Susan B Rempe, C Jeffrey Brinker
The limited flux and selectivities of current carbon dioxide membranes and the high costs associated with conventional absorption-based CO2 sequestration call for alternative CO2 separation approaches. Here we describe an enzymatically active, ultra-thin, biomimetic membrane enabling CO2 capture and separation under ambient pressure and temperature conditions. The membrane comprises a ~18-nm-thick close-packed array of 8 nm diameter hydrophilic pores that stabilize water by capillary condensation and precisely accommodate the metalloenzyme carbonic anhydrase (CA)...
March 7, 2018: Nature Communications
Jacob A Martin, Christopher R Mayhew, Amanda J Morris, Angela M Bader, Mitchell H Tsai, Richard D Urman
Background: Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. Methods: In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology...
April 2018: Journal of Clinical Medicine Research
Alexander Kypta, Hermann Blessberger, Juergen Kammler, Alexander Nahler, Kurt Neeser, Michael Lichtenauer, Christoph Edlinger, Joerg Kellermair, Daniel Kiblboeck, Thomas Lambert, Johannes Auer, Clemens Steinwender
INTRODUCTION: Intra-operative complications like mechanical damages to the leads, infections and hematomas during generator replacements of implantable pacemakers and defibrillators contribute to additional costs for hospitals. The aim of this study was to evaluate operation room use, costs and budget impact of generator replacements using either a traditional surgical intervention (TSI) with scissors, scalpel and electrocautery vs. a new radiofrequency energy based surgical system, called PEAK PlasmaBladeTM (PPB)...
2018: PloS One
N Mundi, J Theurer, A Warner, J Yoo, K Fung, D MacNeil, S Dhaliwal, E Winquist, D A Palma, A C Nichols
Background: Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre. Methods: A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated...
February 2018: Current Oncology
Manraj N Kaur, Feng Xie, Andrea Shiwcharan, Lisa Patterson, Yaron Shargall, Christian Finley, Colin Schieman, Terry Dalimonte, Christine Fahim, Waël C Hanna
BACKGROUND: The objective of this study is to compare robotic portal (RP) to video-assisted thoracoscopic surgery (VATS) pulmonary resections for early stage non-small cell lung cancer with respect to health care resource utilization during the first year of a robotic surgery program in thoracic oncology. METHODS: Patients who underwent anatomic lung resections using RP (n = 42) or VATS (n = 96) for early stage non-small cell lung cancer between April 2014 and March 2015 at a single institution were identified...
March 2, 2018: Annals of Thoracic Surgery
Germain Forestier, Laurent Riffaud, François Petitjean, Pierre-Louis Henaux, Pierre Jannin
PURPOSE: Surgery is one of the riskiest and most important medical acts that are performed today. The need to improve patient outcomes and surgeon training, and to reduce the costs of surgery, has motivated the equipment of operating rooms with sensors that record surgical interventions. The richness and complexity of the data that are collected call for new methods to support computer-assisted surgery. The aim of this paper is to support the monitoring of junior surgeons learning their surgical skill sets...
March 3, 2018: International Journal of Computer Assisted Radiology and Surgery
Mireia Miquel, Montserrat Clèries, Mercedes Vergara, Emili Vela
BACKGROUND: Cirrhosis is a chronic disease with high morbidity and mortality. Few studies have evaluated healthcare resource use in patients with cirrhosis. OBJECTIVE: We aimed to describe the point prevalence of cirrhosis on 31 December 2012 and the population-level distribution of healthcare resource use and expenditures in a non-selected population of patients with cirrhosis, stratified by whether their disease was compensated or decompensated, and by comorbidity burden...
March 3, 2018: BMJ Open
Jason Chui, Rasha Saeed, Luke Jakobowski, Wanyu Wang, Basem Eldeyasty, Angel Zhu, LeeAnne Fochesato, Ronit Lavi, Daniel Bainbridge
BACKGROUND: A routine chest X-ray (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. We sought to assess the value of a routine post-procedural CXR in the era of ultrasound-guided CVC insertion. METHODS: We performed a population-based retrospective cohort study to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008 and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion...
February 28, 2018: Chest
Mario Franchini, Giuseppe Lippi, Stefano Calzolari, Giovanna Giarrè, Giampietro Gubbini, Ursula Catena, Attilio Di Spiezio Sardo, Pasquale Florio
STUDY OBJECTIVE: To compare the costs of hysteroscopic polypectomy using mechanical and electrosurgical systems in the hospital operating room and an office-based setting. DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Tertiary referral hospital and center for gynecologic care. PATIENTS: Seven hundred and fifty-four women who underwent endometrial polypectomy between January 20, 2015, and April 27, 2016...
March 2018: Journal of Minimally Invasive Gynecology
Christopher P Childers, Melinda Maggard-Gibbons
Importance: Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. Objectives: To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect...
February 28, 2018: JAMA Surgery
Peter A Najjar, Stanley W Ashley
No abstract text is available yet for this article.
February 28, 2018: JAMA Surgery
Erica Y Xue, Laurel K Chandler, Stephen L Viviano, Jonathan D Keith
OBJECTIVE: Forward-looking infrared (FLIR) thermography technology uses a handheld camera that measures skin infrared emissivity, captures photographs, and can be analyzed through specialized software. Forward-looking infrared images can be used to analyze and correlate burn wound temperature with burn depth, burn progression, and the number of days needed for healing. FLIR ONE is a miniature, smartphone-compatible thermal imaging camera that has been used to assess inflammation in diabetic foot ulcers, as well as locating perforators in flap surgery...
February 28, 2018: Annals of Plastic Surgery
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