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Putting the value framework to work in surgery.

Kenan W Yount1, Florence E Turrentine1, Christine L Lau1

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The value of surgical services generally increased from 2002-2012, but this rise was driven by general surgery, while vascular surgery value declined due to rising costs associated with new technologies.

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Area of Science:

  • Health economics
  • Surgical outcomes research
  • Healthcare value assessment

Background:

  • Value-based healthcare frameworks define value as outcomes per dollar spent.
  • Few institutions quantify their healthcare delivery on these dimensions.
  • Measuring surgical service value is crucial for institutional improvement.

Purpose of the Study:

  • To measure the value of surgical services over a decade (2002-2012).
  • To analyze trends in surgical value and identify contributing factors.
  • To provide a benchmark for value-based surgical care.

Main Methods:

  • Utilized American College of Surgeons NSQIP data for 25,453 general and vascular surgery patients.
  • Risk-adjusted morbidity and mortality data to create a quality numerator (observed-to-expected ratios).
  • Calculated patient hospitalization costs as the denominator; analyzed value trends using linear regression.

Main Results:

  • Overall surgical value increased from 2002-2012.
  • General surgery value increased more than vascular surgery value.
  • Vascular surgery value decreased due to significantly higher cost increases ($474/year) from 2006-2010, linked to endovascular technology adoption.

Conclusions:

  • Calculating risk-adjusted value in surgical services is essential for providers.
  • This measurement aids in improving outcomes and avoiding inappropriate cost containment.
  • Understanding value is critical for assessing the costs of healthcare innovation.