Delayed Operating Room Access Raises Costs

Despite similarities in patient outcomes, a short delay in the time of operating room availability for urgent cases was associated with significantly increased hospital costs in a retrospective study of patients undergoing appendectomy. The added costs were deemed likely due to hospital inefficiencies, according to the results published in the August issue of Surgery.

The study comprised 443 patients with acute appendicitis treated by appendectomy at a single institution between 2004 and 2009. Perforated or gangrenous appendicitis occurred in 13% of the patients, 4.9% had a pathologically normal appendicitis, and 24.5% of the patients underwent open appendectomy.

The patients had a mean age of 34.9 years, with an average gap time (the time from case booking to surgery start) of 224 minutes. The hypothesis was that operating room (OR) availability as measured by gap time would be related to total cost for hospitalization, according to Dr. Rajeev Dhupar and his colleagues at the University of Pittsburgh (Surgery 2011;150:299-305).

Patients were stratified with a cutoff gap time of 1, 2, 3, and 4 hours for final analysis. The average cost for patients with a gap time of less than 2 hours was $6,862 vs. $9,558 for a gap time of greater than 2 hours – a significant 39% difference. When costs were allocated to different services within the hospital, surgery and laboratory costs were statistically significant contributors to the difference.

The authors speculated that gap time is likely capturing a general difference in the efficiency of care for the patient associated with peak times in the use of the OR.

They found that patients with longer gap times had significantly longer surgery times and significantly higher costs of surgery ($3,657 at less than 2 hours’ gap time vs. $4,330 for greater than 2 hours) and laboratory costs ($294 vs. $469, respectively), with almost every other cost allocation trending higher. For example, costs for nursing were $1,138 vs. $1,495.

There was no significant difference in total length of stay with regard to gap time, "suggesting these incremental costs are in fact caused by hospital inefficiency rather than a difference in a duration of service," the researchers wrote.

They speculated that their "counterintuitive" findings that "peak times of OR activity are also the less efficient" could be because "although maximum daytime operating use might offset fixed costs in that single-cost center, this could be negated by a higher overall cost of care for urgent cases." They also speculated that this might also apply to elective cases and not just urgent ones.

"We anticipate that this finding for the care of appendicitis will hold true for most if not all urgent care cases. Such data might facilitate a true cost-benefit analysis that ultimately would drive hospital management toward optimal efficiency rather than optimal capacity," the researchers concluded.

Study limitations included the fact that costs are analyzed from the perspective of the hospital and do not reflect the direct cost to the payer. In addition, using total loaded hospital costs has significant limitations in truly representing the variable costs that can be allocated to an individual patient, according to the researchers.

The authors reported no disclosures relevant to the study as determined by the journal.

Despite similarities in patient outcomes, a short delay in the time of operating room availability for urgent cases was associated with significantly increased hospital costs in a retrospective study of patients undergoing appendectomy. The added costs were deemed likely due to hospital inefficiencies, according to the results published in the August issue of Surgery.

The study comprised 443 patients with acute appendicitis treated by appendectomy at a single institution between 2004 and 2009. Perforated or gangrenous appendicitis occurred in 13% of the patients, 4.9% had a pathologically normal appendicitis, and 24.5% of the patients underwent open appendectomy.

The patients had a mean age of 34.9 years, with an average gap time (the time from case booking to surgery start) of 224 minutes. The hypothesis was that operating room (OR) availability as measured by gap time would be related to total cost for hospitalization, according to Dr. Rajeev Dhupar and his colleagues at the University of Pittsburgh (Surgery 2011;150:299-305).

Patients were stratified with a cutoff gap time of 1, 2, 3, and 4 hours for final analysis. The average cost for patients with a gap time of less than 2 hours was $6,862 vs. $9,558 for a gap time of greater than 2 hours – a significant 39% difference. When costs were allocated to different services within the hospital, surgery and laboratory costs were statistically significant contributors to the difference.

The authors speculated that gap time is likely capturing a general difference in the efficiency of care for the patient associated with peak times in the use of the OR.

They found that patients with longer gap times had significantly longer surgery times and significantly higher costs of surgery ($3,657 at less than 2 hours’ gap time vs. $4,330 for greater than 2 hours) and laboratory costs ($294 vs. $469, respectively), with almost every other cost allocation trending higher. For example, costs for nursing were $1,138 vs. $1,495.

There was no significant difference in total length of stay with regard to gap time, "suggesting these incremental costs are in fact caused by hospital inefficiency rather than a difference in a duration of service," the researchers wrote.

They speculated that their "counterintuitive" findings that "peak times of OR activity are also the less efficient" could be because "although maximum daytime operating use might offset fixed costs in that single-cost center, this could be negated by a higher overall cost of care for urgent cases." They also speculated that this might also apply to elective cases and not just urgent ones.

"We anticipate that this finding for the care of appendicitis will hold true for most if not all urgent care cases. Such data might facilitate a true cost-benefit analysis that ultimately would drive hospital management toward optimal efficiency rather than optimal capacity," the researchers concluded.

Study limitations included the fact that costs are analyzed from the perspective of the hospital and do not reflect the direct cost to the payer. In addition, using total loaded hospital costs has significant limitations in truly representing the variable costs that can be allocated to an individual patient, according to the researchers.

The authors reported no disclosures relevant to the study as determined by the journal.

Despite similarities in patient outcomes, a short delay in the time of operating room availability for urgent cases was associated with significantly increased hospital costs in a retrospective study of patients undergoing appendectomy. The added costs were deemed likely due to hospital inefficiencies, according to the results published in the August issue of Surgery.

The study comprised 443 patients with acute appendicitis treated by appendectomy at a single institution between 2004 and 2009. Perforated or gangrenous appendicitis occurred in 13% of the patients, 4.9% had a pathologically normal appendicitis, and 24.5% of the patients underwent open appendectomy.

The patients had a mean age of 34.9 years, with an average gap time (the time from case booking to surgery start) of 224 minutes. The hypothesis was that operating room (OR) availability as measured by gap time would be related to total cost for hospitalization, according to Dr. Rajeev Dhupar and his colleagues at the University of Pittsburgh (Surgery 2011;150:299-305).

Patients were stratified with a cutoff gap time of 1, 2, 3, and 4 hours for final analysis. The average cost for patients with a gap time of less than 2 hours was $6,862 vs. $9,558 for a gap time of greater than 2 hours – a significant 39% difference. When costs were allocated to different services within the hospital, surgery and laboratory costs were statistically significant contributors to the difference.

The authors speculated that gap time is likely capturing a general difference in the efficiency of care for the patient associated with peak times in the use of the OR.

They found that patients with longer gap times had significantly longer surgery times and significantly higher costs of surgery ($3,657 at less than 2 hours’ gap time vs. $4,330 for greater than 2 hours) and laboratory costs ($294 vs. $469, respectively), with almost every other cost allocation trending higher. For example, costs for nursing were $1,138 vs. $1,495.

There was no significant difference in total length of stay with regard to gap time, "suggesting these incremental costs are in fact caused by hospital inefficiency rather than a difference in a duration of service," the researchers wrote.

They speculated that their "counterintuitive" findings that "peak times of OR activity are also the less efficient" could be because "although maximum daytime operating use might offset fixed costs in that single-cost center, this could be negated by a higher overall cost of care for urgent cases." They also speculated that this might also apply to elective cases and not just urgent ones.

"We anticipate that this finding for the care of appendicitis will hold true for most if not all urgent care cases. Such data might facilitate a true cost-benefit analysis that ultimately would drive hospital management toward optimal efficiency rather than optimal capacity," the researchers concluded.

Study limitations included the fact that costs are analyzed from the perspective of the hospital and do not reflect the direct cost to the payer. In addition, using total loaded hospital costs has significant limitations in truly representing the variable costs that can be allocated to an individual patient, according to the researchers.

The authors reported no disclosures relevant to the study as determined by the journal.