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Operative time and cost variability for functional endoscopic sinus surgery
Author(s) -
Thomas Andrew J.,
Smith Kristine A.,
Newberry Christopher I.,
Cardon Brandon,
Davis Brock,
Ou Zhining,
Presson Angela P.,
Meier Jeremy D.,
Alt Jeremiah A.
Publication year - 2019
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22198
Subject(s) - medicine , endoscopic sinus surgery , confidence interval , surgery , cost analysis , engineering , reliability engineering
Background Understanding the variation in costs of endoscopic sinus surgery (ESS) is critical to defining value. Current published costs of ESS have not identified potential sources of variation. Our objective was to analyze ESS costs to identify sources of variance that could guide value‐improving decisions. Methods ESS cases (n = 1739) performed between 2008 and 2016 were identified from a database of 22 rural to tertiary facilities. Cost and time data were extracted from the database. Medical records were reviewed to confirm procedures. Three bilateral groupings were examined (n = 895 cases from 13 facilities): (1) full ESS (all sinuses); (2) intermediate ESS (total ethmoid, maxillary); and (3) anterior ESS (anterior ethmoid, maxillary). Cost and operative time were analyzed using multivariable gamma regression. Results Median costs for full, intermediate, and anterior ESS were $4281, $3716, and $2549 U.S. dollars ( p < 0.001). Median durations were 87, 60, and 58 minutes ( p < 0.001). Among patients with no additional procedures, those with full ESS had operative duration, total cost, and supply costs that were 1.37 (95% confidence interval [CI], 1.17 to 1.61), 1.52 (95% CI, 1.32 to 1.75), and 2.40 (95% CI, 1.76 to 3.25) times greater than anterior ESS, respectively (all p < 0.001). Intermediate ESS duration at community urban facilities was 1.87 (95% CI, 1.74 to 2.02) times that of community rural facilities ( p < 0.001). Conclusion Duration of surgery, extent of surgery, and location of surgery are sources of significant variation in the cost of ESS. These findings will assist healthcare policy makers, hospitals, and surgeons in optimizing the value of ESS.