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We assessed surgeon knowledge of commonly used instruments and disposable items and described attitudes toward incorporating cost data into daily practice.
An electronic, based survey was distributed to faculty and trainees in the University of California San Francisco (UCSF) Department of Urology. The 26-question survey assessed opinions regarding general operating room supply cost information and specific costs of 10 supplies used for laparoscopic nephrectomy. A response was considered accurate when it fell within 50% of the actual cost.
The response rate was 71% among faculty (13) and 90% among trainees (17). Overall 55% of faculty and 82% of trainees considered their knowledge of costs &#;fair&#; or &#;poor.&#; The overall accuracy of cost estimation for 10 commonly used supply items was 27% (SD ± 45%), with no significant difference between trainees and faculty (p=0.70). Accuracy was not associated with self-reported cost knowledge (p=0.25) or number of laparoscopic nephrectomies performed (p=0.47). Of the faculty 33% and of the trainees 41% reported that having more knowledge of costs would motivate them to decrease their operating room supply costs, and 42% of faculty raised the idea of an incentive program. Overall 75% of study participants believe that there is &#;too little&#; or &#;not enough&#; emphasis placed on cost awareness.
Trainees and faculty generally have poor knowledge of operating room supply costs. In our academic setting we noted an interest among faculty and residents to make cost data more accessible. These data would provide an opportunity for surgeons to act as cost arbiters in the operating room.
Keywords:
equipment and supplies, surgical procedures, operative, costs and cost analysis, laparoscopy, nephrectomy
Nearly a fifth of the United States gross domestic product is spent on health care, with costs escalating at an unsustainable rate.1 National health spending is projected to increase at an average of 5.6% per year for to , with health spending projected to grow 1.2 percentage points faster than gross domestic product per year during the same period.2 Physicians have influence over the selection of medical supplies and the delivery of medical care, and by some estimates can carry influence over nearly 60% of health care expenditures.3 Few physicians receive training or education on their role as stewards of cost containment.4
Cost awareness is an important step toward cost containment. Recently published studies in several surgical disciplines demonstrate that physicians across all levels of training have poor knowledge of medical device costs.5 A national survey of orthopedic surgeons across 7 institutions demonstrated that attending surgeons estimate costs correctly only 21% of the time, with estimates ranging from 1.8% of to nearly 25 times the actual price.6 An otolaryngology study of 2 major Canadian institutions found only 30% accuracy in cost estimates of commonly used consumable items.7 Overall there is a paucity of data describing awareness of operating room costs in the urological literature.8,9
Surgeons have a large role in supply selection, which has the potential to significantly impact health care costs. We assessed surgeon knowledge of commonly used instruments and disposable items in the operating room. Furthermore, we describe attitudes and perceived barriers toward incorporating cost data into daily practice. Our hypothesis is that surgeon knowledge of operating room costs would lead to greater cost containment.
We performed a cross-sectional analysis to ascertain attitudes toward and awareness of operating room costs. The study cohort consisted of all the attending surgeons, fellows and residents in the University of California San Francisco Department of Urology in . All participating faculty were based at UCSF Medical Center. We distributed an anonymous electronic survey using REDCap (Research Electronic Data Capture) via , and sent 2 additional reminders to complete the survey to improve the response rate.
Our questionnaire design was based on similar cost awareness studies used in other disciplines and adapted to reflect our practice environment. The survey comprised 26 questions and was divided into 2 sections. The first section consisted of 9 questions aimed to assess perceived knowledge of operating room cost and engagement in the process of obtaining cost information. The questions used Likert-like scales to elicit the responses and had 2 free response questions to allow physicians to write in responses about motivations and information dissemination preferences (supplementary Appendix, http://urologypracticejournal.com/). The second part of the survey aimed to assess cost awareness by asking the approximate cost in U.S. dollars of 10 commonly used items in the operating room, and by asking participants to choose which was more expensive in a pair of similar supply items. We focused on supplies and materials frequently used in laparoscopic nephrectomy, a commonly performed surgery at our institution across a broad range of subspecialists and one in which we thought most urologists would have had previous experience. For this study cost was defined as the amount the institution pays for the supply item.
We compared respondent cost estimates to amounts obtained from the price list at our institution. A response was considered accurate when it fell within 50% of the actual cost. We obtained information on level of training and number of laparoscopic nephrectomies performed for each participant. Analyses were conducted using chi-squared and rank sum tests and stratified by level of training. A p value less than 0.05 was considered statistically significant. Institutional review board approval was obtained (IRB No. 17&#;).
The survey response rate was 71% among faculty and 90% among trainees. Of the 30 respondents 13 were attending physicians and 17 were residents or fellows. Of the 12 residents who participated in the study 58.3% were senior residents (postgraduate year 4&#;6) and 41.7% were junior residents (postgraduate year 2&#;3). Among the faculty 77% had been in practice for more than 5 years. Across all levels of training 33% of respondents reported participating in more than 10 laparoscopic nephrectomies in the last year, with 60% of those respondents performing more than 20 cases.
The majority of study participants self-rated their cost supply knowledge as &#;fair&#; or &#;poor,&#; regardless of training level ( ). When given a free text opportunity to describe how participants would like to be provided with cost information, more than 60% requested an itemized list of supplies that includes cost, with 38% of attendings requesting information about costs of supplies they use as well as possible alternatives. In describing the factors that would motivate attending physicians to decrease their supply costs, 33% listed knowledge of costs as motivation to change behavior and 42% recommended some type of financial incentive model. Overall 69% of faculty members reported that cost &#;often&#; or &#;sometimes&#; has a role in their choice of supplies and 75% believed that there is &#;too little&#; or &#;not enough&#; emphasis placed on cost awareness at our institution ( ).
Open in a separate windowThe combined accuracy of cost estimates for the 10 commonly used supply items was 27% (SD 45%) with no statistically significant difference between trainees and faculty (p=0.70, ). To pool estimates across different supply items, each item estimate was converted to a percentage of the item&#;s actual cost and median percent differences and ranges were calculated for each individual item as well as for the aggregate of the items. There was no significant difference in the median relative estimates of supplies between faculty and trainees (median 286% vs 276%, p=0.31, ). A participant was more likely to overestimate the cost of an item if the cost was relatively low. Among those items for which the costs were overestimated, the average actual cost was $87±18, while items that were underestimated had an average actual cost of $275±44 (p <0.001). When evaluating the more expensive of a pair of supply items with respect to cost estimate accuracy, there was no significant difference in accuracy between the faculty and the residents (p=0.59). Accuracy was not associated with number of laparoscopic nephrectomies performed (p=0.47) or self-reported cost knowledge (p=0.25).
Open in a separate windowUrological trainees and faculty have poor operating room supply cost awareness despite describing an interest in cost knowledge. The overall accuracy of estimation for 10 commonly used supply items was 27% (SD 45%), with no significant difference between trainees and faculty (p=0.70). The majority of study participants recognized that their cost knowledge is &#;poor&#; or &#;fair.&#; However, reporting that knowledge was &#;good&#; or &#;excellent&#; did not predict greater accuracy. These results are consistent with similar accuracy findings in other disciplines, ie 12% to 25% in an otolaryngology study7 and 17% to 21% in an orthopedic surgery study.6 While there is no industry standard for defining accuracy, describing an estimate within 50% of actual cost as &#;accurate&#; has been used in other disciplines. Repeating our calculations with a 25% cutoff reveals our overall accuracy estimation to be 11%, which is on the lower edge of other groups.
We noted that our respondents were more likely to overestimate the costs of less expensive items, especially items priced less than $100, and underestimate items that were more expensive, with a median overestimation of 57% for all responders. An otolaryngology group also found that their respondents overestimated the costs of items, with a median overestimation of 10% by faculty and 29% overestimation by trainees, with greater overestimation of lower cost items.7 We did not include anchor numbers in our survey, asking for free text estimates and, thus, these responses indicate true lack of cost awareness among our respondents. Not knowing actual costs diminishes the ability to truly factor costs into the decision making, regardless of internal bias toward overestimation.
Improved cost knowledge and awareness have been demonstrated to lower the costs of care.10 Emergency departments and primary care settings have recognized the role of educating physicians as an important part of cost containment efforts, and have demonstrated success with these projects.10,11 A single health system, multidisciplinary study at our institution using individualized monthly surgeon score cards informing surgeons of their median surgical supply costs compared to their peers demonstrated a near 10% supply cost decrease in the intervention group.12&#;14 Another multihospital health system reported a 10% reduction in laparoscopic cholecystectomy supply costs and a 21% reduction in laparoscopic inguinal herniorrhaphy supply costs by presenting surgeons with an itemized supply list, including less costly alternatives. This intervention was aimed solely at improving individual knowledge, without standardization or offering any incentive or punitive measures.15,16
We have previously reported that even a single institution can have significant supply cost variations for common cases. For example, there was significant variation in expenses between individual surgeons performing the same procedure, with median supply costs ranging from $1,642 to $4,524 for laparoscopic nephrectomy.17 Standardization has the potential to yield significant cost savings. For example, implementation of a standardized preference card for laparoscopic appendectomy at another institution was able to yield a 20% reduction in supply cost per case in a single hospital system.18 Focus on standardization and optimization of supply lists can contribute to decreasing variability in costs.
Further efforts can incorporate incentives to change surgeon behavior. One successful group used an agreement to standardize to one type of supply item and a 50&#;50 shared savings incentive program for the surgeons and the hospital, and they were able to report $890,000 in savings by changing 3 specific supply items across 2 years.19 In our study sample many surgeons suggested incentives as a means to encourage cost savings. Some gain sharing models split savings into hospital and department in whole, and others reward physicians who save the institution money with financial support for physician assistants, new equipment or research funding. Although gain sharing models have been explored in general and orthopedic surgery, these interventions have not been replicated in urology.15,19&#;21
Our study demonstrated that most attendings and trainees believe that we should place more emphasis on cost awareness in the operating room, suggesting that a focused effort on cost awareness could lead to changing behavior. Trainees are being evaluated on their ability to &#;incorporate cost awareness&#; into patient care as part of the &#;System Based Practice&#; competency of the ACGME (Accreditation Council for Graduate Medical Education) resident milestones. Given the low knowledge of costs among faculty in our study and in other reports in the literature, it appears that our expectations from trainees may not be matched by the training they are provided.
We believe that inciting a productive conversation about standardization of costs and meaningful incentives, efforts to reinforce the habits of those already pursuing cost savings, and encouragement of increased participation among those just becoming cost aware can lead to significant strides in this arena. We have started to engage in these discussions at our institution with an overwhelmingly positive response. Urology is at the forefront of integrating expensive technological advances into surgical practice. With the rising costs of health care, we have a responsibility to train knowledgeable surgeons to serve as cost arbiters in providing high quality and high value care.
Although our accuracy findings are consistent with other reports in the literature, it is important to consider the limitations of this study. We sampled a single department in an academic institution, and while this may be generalizable among academic practices, it may not be representative of community and nontraining environments. Private practice groups&#; profitability can vary based on their ability to contain costs, and they may have more say in ordering practices than academic and Veterans Affairs institutions. In noncapitated compensation models cost containment efforts can conversely reduce profitability by decreasing margins on disposables. Furthermore, prices can fluctuate depending on changes in purchase contracts and staying current on these developments requires a significant time commitment. Another limitation is the large number of subspecialists in our department who may not be performing laparoscopic cases frequently and be less familiar with that equipment. We assessed whether surgeons who perform more laparoscopic nephrectomies have greater accuracy and did not find a statistically significant difference. Lastly, while our response rate among faculty was 71%, our overall response rate was 81%, which limits susceptibility to nonresponder bias.22,23
In our single center academic training program survey of 30 urological surgery attendings and trainees, we found poor knowledge of operating room supply costs. We noted a high interest in learning costs of supplies and in making cost data more readily accessible, as well as a desire for greater emphasis on cost awareness. Surgeons have an important role as cost arbiters in the operating room, and having access to these data and appropriate incentives to implement changes in practice are important steps toward health care cost containment.
No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article.
Supplementary Data.
NIHMS-supplement-Supplementary_Data.doc(349K)
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Increased health care spending concerns have generated interest in reducing operating room (OR) costs, but the cost awareness of the surgical team selecting intraoperative supplies remains unclear. This work characterizes knowledge of supply cost among surgeons and OR staff in a large academic hospital and seeks to examine the role of experience and training with regards to cost insight.
This work is a cross-sectional study of surgeons, trainees, nurses, and surgical technicians (n = 372) across all surgical specialties at a large academic hospital. Participants completed a survey reporting frequency of use and estimated cost for 11 common surgical supplies as well as opinions on access to cost information in the OR. Cost estimation error was expressed as the ratio of estimated-to-actual cost, and groups were compared with one-way analysis of variance and chi-squared testing. Spearman correlation (ρ) was used to describe the relationship between monotonic variables.
Overestimation error was universal and ranged widely (3.80&#;49.79). There was no significant difference in estimation accuracy when stratified by role or years of experience. Less expensive items had higher rates of estimation error than more expensive items (P < 0.001), and a moderately strong relationship was found between decreased item cost and increased estimation error (ρ: 0.49). The overwhelming majority (91%) of respondents expressed a desire to learn more about supply pricing.
Price knowledge of common supplies is globally impaired for entire surgical team but coexists with a strong desire to augment cost awareness. Improved access to cost information has a high potential to inform surgical decision-making and decrease OR waste.
Keywords:
Cost awareness, Surgical cost, Cost containment, Intraoperative supply cost, Surgical supply cost
In an effort to curtail rising health care costs in the United States, hospital administrators have increasingly turned a scrutinizing eye toward operating rooms (ORs) and the surgeons who work in them. The cost of major surgical procedures is both unregulated and widely variable among institutions,1 and ORs are a component of hospital infrastructure with not only high operating costs but also a high potential for wasted consumables.1 The cost of running an OR has been calculated as roughly $37 per minute or $ per hour.2 Surgical waste is also a major issue, with wasted supplies as making up 20% of the total supply cost in the ORs at a single teaching hospital3 and a known association between emergency procedures and a large number of wasted supplies.4
In light of these figures, a number of research efforts have sought to elucidate factors that contribute to OR waste. Differences in surgeon preferences for surgical supplies and implants have been shown to be responsible for a large portion of intraoperative cost variation within the same procedure.5&#;7 Education of surgeons regarding the cost of supplies has shown to be an effective means of significantly reducing the cost variation, with various studies citing a 10%&#;21% decrease in cost after the implementation of surgeon education initiatives.5&#;7
Despite an increasing body of evidence that increased surgeon education with respect to supply costs is an effective means of reducing OR expenditures, all available evidence in the literature is that surgeon awareness of supply costs is severely limited. One study noted that orthopedic surgeons could accurately estimate the cost of the devices they implanted only 21% of the time.8 Other efforts investigating cost awareness with respect to more common and lower cost supplies demonstrated a similarly high level of ignorance among surgeons of all levels of training, with only 14%&#;25% accuracy cited in these studies.9&#;11
Although some research attention has been turned toward surgeons and their ability to influence OR waste, OR staff frequently participate in both purchasing committees as well as making intraoperative decisions regarding supply selection. It has been demonstrated that infrastructure-related factors, that is hospital-level purchasing decisions and supply availability, can have a more significant effect on cost variability than individual surgeon practice patterns.12 This work characterizes the knowledge of supply costs among surgeons as well as OR staff in a large academic hospital and seeks to examine the role of experience and training with regard to cost awareness among members of the team.
This is a cross-sectional study using a survey tool to gather data from the surgeons, trainees, and OR staff members at the Johns Hopkins Hospital. The study and the survey items were reviewed and approved by the Institutional Review Board of the Johns Hopkins Hospital. The survey tool was administered by to all OR nurses and surgical technicians as well as surgeons and surgical trainees (fellows and residents) in all surgical disciplines. The response was on a voluntary basis. The need for informed consent was waived by the Institutional Review Board.
The study population was purposely selected as a representative multidisciplinary cross-section of all persons who actively participate in the decision-making process of pulling, opening, and using surgical supplies in the OR; no persons were included who would not be regularly exposed to the survey items as part of the responsibilities associated with their job. We purposely included surgeons and staff in all surgical disciplines, including general, urology, orthopedics, neurosurgery, otolaryngology, plastics, obstetrics and gynecology, and cardiac and vascular surgery. The survey consisted of photos, descriptions, and manufacturer information for 11 general items frequently used in the ORs at our institution ( ). For each item, the respondent was asked to estimate the dollar amount of the item in US dollars to the nearest cent as a free-text item and then was asked a multiple-choice item inquiring the frequency with which they encountered this item (on a daily, weekly, monthly, or yearly basis or never). The actual cost of the items was defined as the negotiated cost of the item to the institution to acquire said item; because of the differences in Medicare and private insurance reimbursements, the billed cost to the patient of each item was variable and beyond the scope of this investigation. As part of the survey, respondents also were asked to select their role in the OR and then the number of years they had been in that role&#;trainees were all asked to select post-graduate year of training. Additional items asked whether or not the respondent had been involved in OR purchasing committees and their attitudes toward the role of supply cost toward OR decision-making and whether they felt their demographic would benefit from more training regarding the cost of OR supplies.
Data from the survey were analyzed using Stata Version 14.2 (StataCorp LLC, College Station, TX). Continuous variables were analyzed with one-way analysis of variance testing and categorical variables with chi-squared testing. Estimation error was expressed as the ratio of estimated to actual cost, transformed logarithmically where appropriate to facilitate graphic presentation. Spearman correlation (ρ) was calculated to assess the relationship between monotonic variables.
Overall, a total of 777 surveys were administered, with 372 responses for a 47.9% overall response rate; these results are summarized in . The highest response rates were seen among registered nurses (RNs; 63.7%) and surgical trainees, with attending surgeons and surgical techs responding at lower rates (35.6 and 37%, respectively). Surgeons and RNs had the highest average level of experience (10.1 and 10.7 y, respectively), whereas residents had significantly less (1.8 y; P < 0.001).
When examining estimated versus actual costs, there was a large amount of variation in the estimated costs for the various common items, with most respondents overestimating the cost of the survey items. Actual and maximum estimated costs are portrayed in ; of note, the most expensive item, a skin adhesive costing <$20, was estimated by one respondent to cost $750. The range of overestimation by item is also portrayed in . The estimation error ranged from 3.80 to 49.79 times the actual cost; the lowest and highest rates of overestimation pertained to the highest and lowest cost items, respectively, is represented graphically in as box and whisker plots; the untransformed data are shown in panel A and after logarithmic transformation in panel B. The estimation error was significantly higher for low-cost items (P < 0.001). On comparison, the rate of overestimation was found to be moderately correlated with actual item cost (ρ: 0.49).
Open in a separate windowResponses were further subdivided by item, role, and frequency of use. These results are portrayed in as bar graphs. There were no statistically significant differences in estimation error within items by frequency of use (panel A, P = 0.06) and no significant differences in estimation error when subdivided by role in the OR (panel B, P = 0.06) or years of work experience (panel C, P = 0.77).
Open in a separate windowOverall, there was an agreement with the statement, &#;Should personnel receive more training about supply prices?&#; with 335 positive responses (91%; ). This was similarly reflected in the responses of agreement with the statement, &#;Price should factor into decision-making in the operating room,&#; with 346 positive responses (93%). There were no significant differences in the responses to the survey questions inquiring about the respondent&#;s desire for additional cost awareness training when broken down by years of experience (panel A, P = 0.75) or by surgical role (panel B, P = 0.31).
Open in a separate windowIn general, the data presented here reaffirm the lack of knowledge by surgeons and surgical trainees with respect to supply costs and a high level of desire to augment that knowledge. Beyond that, we also demonstrate that this phenomenon extends to nursing and surgical technicians as well and is irrespective of years of experience in a surgical setting. Previous data have estimated that 75%&#;90% of surgeons cannot accurately estimate cost9,10,13; however, these outcomes are determined by a variable definition of what constitutes accuracy. Therefore, in the present work, we opted to report data in the form of logarithmically transformed estimation error, which ranged from 0.86 to 3.19, or an untransformed overestimation of 3.80&#;49.79 times the actual cost. This high level of error persisted regardless of the number of years the individual had worked in the OR, how frequently the individual used that item, and the individual&#;s role in the OR (surgeon, trainee, nurse, and surgical tech). Similarly, even for those individuals involved in purchasing committees, this activity did not seem to reduce estimation error for this set of common supplies.
Overall, this indicates that the health care system, in general, does a poor job of educating trainees and staff about cost, and that this has been the case for years. The pervasive ignorance of price that is repeatedly demonstrated among surgeons and OR staff is largely a product of the economic structure of modern health care.13 As employees of hospitals rather than independent proprietors, surgeons act as intermediaries in the delivery of health care. This role as neither true consumer nor true seller largely insulates surgeons and OR staff from changes in supply and implant price. Therefore, this group does not respond organically to changes in price in a way that would be predicted for sellers and consumers in a more straightforward economy.14&#;16 In a number of ways, this is by design: surgeons and their allies in providing health care should be shielded from cost in a way that allows them to make intraoperative decisions that are patient driven, not cost driven.15 That said, complete naiveté with respect to cost is problematic and can beget needless waste.
Clearly, the level of desire among surgeons and OR staff to receive this cost information is high, with 66%&#;90% of respondents to the present and other similar surveys, indicating that they want to know more about supply cost and use it to inform decision-making.9,10,13 The use of individualized surgeon scorecards and peer education from surgeons identified as having low procedural costs has resulted in a 10%&#;21% decrease in per procedure costs.5,7 Even more simply, one study focused on orthopedic trauma used a simple color designation to rate the cost of implants, which was posted on the wall in the OR. This simple, almost passive intervention served to increase affordable implant use by 56% (P < 0.), translating into a cost savings of $216,495 yearly.17 A similar effort announced the costs of consumables aloud to cardiologists performing percutaneous coronary interventions, saving an average of $234.77 per procedure (6%, P = 0.01) with no impact on outcomes.18 Posting or announcing such information within the operative suite has the dual strength of empowering all members of the team, including nurses and technicians, to engage in the decision-making process. All the above positive experiences highlight a repeating theme&#;that education alone can effectively reduce costs without the need for positive or negative incentives for achieved reductions.6
When discussing how to increase the overall value of OR procedures, often much of the discussion is focused on cost reduction; however, increasing quality also serves to increase the value of individual procedures. It is important to remember that overly spartan use of supplies can increase operative times, which can potentially affect outcomes.19&#;21 One study examining elective laparoscopic cholecystectomy at a single institution noted that the lowest cost surgeon with respect to consumable supplies had the longest operative times.22 Cost awareness should not simply be a means of discouraging the use of expensive items but also encouraging the use of low-cost items that may save valuable OR minutes and minimize the duration of anesthesia. Thus far, initiatives to reduce intraprocedural costs have not correlated with impaired outcomes,7,18,23,24 but it is important to keep the potential for harm in mind when aggressive cost reduction is attempted.
The items included in this survey are relatively low-cost items, with the most expensive item, a skin adhesive, costing <$20. This fact dictated the selection of the outcome of estimation error as a ratio rather than as an absolute cost difference. Absolute cost is a valuable endpoint and one that should be taken into consideration particularly with respect to higher cost items where even a small degree of estimation error on an expensive implant will carry considerable weight in the overall cost of the operation. With respect to low-cost items, it is the frequency of their use rather than their absolute cost, which makes cost estimation errors significant; thus, ratio of estimation error was selected to highlight the repercussions of cost ignorance at the low end of the cost spectrum. The relative widespread ignorance with respect to the costs of frequently used items almost certainly signifies a corresponding lack of knowledge with respect to more expensive items. Although there was a moderate relationship detected between decreased item cost and increased magnitude of estimation error (ρ: 0.49), this cannot and should not be extrapolated to assume that more expensive items will inherently be estimated with greater accuracy.
As a final point, intraoperative decisions that govern supply cost are merely one part of the potentially modifiable factors that contribute to the overall cost of a surgical hospital stay. At least one study examining the institutional factors that contribute to surgical supply cost states that the purchasing decisions made by the hospital have a far greater potential to impact procedural supply costs than do individual surgeons.12 The fact that purchasing committee involvement did not correlate with cost knowledge in this study raises questions about the associated benefit to staff knowledge gleaned by serving on such committees, but nonetheless, there is an ongoing need for clinical staff to be engaged in purchasing decisions on an institutional level. Finally, it must be noted that cost savings measures extend beyond the OR. At least one study of surgical cost education initiatives noted that even significant decreases in intraoperative costs did not impact the overall cost of admission.13 Turning cost-savings focus to areas outside the surgical suite, such as toward standardized postoperative pathways for particular procedures, may have a higher potential impact on significantly reducing health care expenditures.
The strengths of this work include its inclusion of multiple surgical disciplines at all levels of training as well as its inclusion of ancillary OR staff within the survey respondents, as prior investigations into OR cost awareness have focused solely on surgeons and surgical trainees, often within a single surgical specialty. Limitations include the survey-based nature of the study, which was returned on a voluntary basis, potentially introducing self-selection bias into the results. Similarly, the heterogeneity of the educational backgrounds and ages of the respondents may have inherently introduced bias into their responses. The general nature of this survey is both a strength and a weakness in that it incorporates the most frequently used items in our ORs; however, its general audience rendered us unable to include more expensive items germane to specific specialties (i.e., robotic components, staplers, orthopedic implants, vascular grafts, meshes, etc.) whose per-use impact on overall operating costs is much higher.
As a whole, these survey results demonstrate a lack of knowledge regarding the cost of common OR supplies, that is, pervasive among surgeons, surgical trainees, and OR staff members. In spite of that, there coexists a general desire among survey respondents to augment their knowledge and apply it to intraoperative decision-making. Providing surgeons with feedback regarding their own cost data in a way that maintains their ability to make patient-centered decisions regarding supply selection is paramount in reducing surgical waste and increasing procedural value. Similarly, initiatives to reduce surgical costs should extend beyond the OR, as standardized postoperative care pathways can have a greater impact on the overall cost of postoperative hospital stays.
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Disclosure
The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Supplementary data
Supplementary data to this article can be found online at https://doi.org/10./j.jss..02.007.
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