Interventions to Reduce Intraoperative Costs: A Systematic Review.

Area of Science:

• Health Economics
• Surgical Cost Management
• Evidence-Based Practice

Background:

• Episode-based payments increasingly transfer financial risk to healthcare providers.
• The operating room (OR) is a high-cost area with potential for savings.
• Maintaining patient safety is paramount when implementing cost-reduction strategies.

Purpose of the Study:

• To systematically review interventions aimed at reducing intraoperative costs.
• To assess the risks and benefits associated with these cost-saving interventions.

Main Methods:

• Systematic literature search of PubMed, Cochrane, and CINAHL (2001-2017).
• Categorization of interventions: instrument standardization, reusable instruments, wound closure, cost feedback, instrument trials, and OR timeliness.
• Analysis of 43 studies (12 RCTs, 31 observational) for cost impact, OR time, length of stay, and adverse events.

Main Results:

• Most interventions demonstrated cost savings, with estimates ranging from -$413 to $3154 per operation.
• Standardization and cost feedback interventions were most robust, yielding savings of $38-$732 per case.
• No significant changes in OR time, length of stay, or adverse events were reported for these interventions.

Conclusions:

• Interventions to reduce intraoperative costs generally show savings without increasing adverse effects.
• Methodological limitations, particularly in cost data, affect the reliability of findings.
• Hospitals can safely reduce costs via instrument standardization and surgeon cost feedback.