Optimizing Costs in Plastic Surgery: A Systematic Review of Time-driven Activity-based Costing Applications

The rising complexity and cost of healthcare in plastic surgery, particularly in resource-intensive procedures like free flap and breast reconstruction, pose significant financial challenges. Time-driven activity-based costing (TDABC) offers a method to accurately assess these costs by mapping each step of the care cycle based on time and resources consumed. Although TDABC has been utilized in high-cost fields such as neurosurgery and spine surgery, its application in plastic surgery remains underexplored. This systematic review evaluates the literature on TDABC use in plastic surgery to identify key cost drivers and propose strategies for cost-efficiency.

A systematic review was conducted on studies applying TDABC, activity-based costing, and cost-to-charge ratio in plastic surgery, sourced from PubMed. Inclusion criteria focused on peer-reviewed studies from the last decade assessing costing strategies in aesthetic and reconstructive plastic surgery, resulting in 17 studies that provided empirical data on cost drivers and resource allocation.

Operating room time, staffing, and postoperative care are identified as primary cost contributors in complex reconstructive surgery, with TDABC highlighting inefficiencies such as prolonged operating room time and unnecessary intensive care unit stays. Cost-saving opportunities were found in optimizing postoperative care and reallocating tasks to lower-cost personnel.

TDABC provides a framework for cost optimization in plastic surgery by offering granular insights into resource utilization, allowing for targeted interventions that reduce expenses without compromising care quality. Future research should explore the application of TDABC to cosmetic procedures and assess its long-term cost-effectiveness in plastic surgery.