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Optimizing Costs in Plastic Surgery: A Systematic Review of Time-driven Activity-based Costing Applications
Emily L Isch1, Gabrielle Kozlowski2, D Mitchell Self3
1From the Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
Plastic and Reconstructive Surgery. Global Open
|June 25, 2025
Summary
Time-driven activity-based costing (TDABC) can optimize plastic surgery costs. This method identifies key cost drivers like operating room time and staffing, enabling targeted interventions for improved efficiency and reduced expenses.
Area of Science:
- Healthcare Economics
- Surgical Cost Analysis
- Plastic Surgery Management
Background:
- Healthcare costs in plastic surgery, especially for complex reconstructions like free flaps and breast reconstruction, are rising.
- Time-driven activity-based costing (TDABC) is a methodology for accurately assessing healthcare costs by analyzing time and resources consumed throughout the patient care cycle.
- While TDABC is established in other high-cost surgical fields, its application in plastic surgery is not well-documented.
Purpose of the Study:
- To systematically review the existing literature on the application of TDABC in plastic surgery.
- To identify the primary cost drivers in complex reconstructive plastic surgery procedures.
- To propose strategies for enhancing cost-efficiency within plastic surgery.
Main Methods:
- A systematic review of studies utilizing TDABC, activity-based costing, or cost-to-charge ratio in plastic surgery was performed.
- Literature was sourced from PubMed, focusing on peer-reviewed studies from the past decade.
- Seventeen studies providing empirical data on cost drivers and resource allocation in aesthetic and reconstructive plastic surgery were included.
Main Results:
- Operating room time, staffing levels, and postoperative care emerged as significant cost contributors in complex reconstructive surgery.
- TDABC analysis revealed inefficiencies, including extended operating room durations and non-essential intensive care unit admissions.
- Opportunities for cost reduction were identified through optimization of postoperative care pathways and task redistribution to less costly personnel.
Conclusions:
- TDABC offers a valuable framework for cost optimization in plastic surgery by providing detailed insights into resource utilization.
- Implementing TDABC allows for targeted interventions to reduce expenses without negatively impacting patient care quality.
- Further research is recommended to explore TDABC's utility in cosmetic surgery and its long-term economic impact on the field.
