• Christopher P Childers, Amy Showen, Teryl Nuckols, and Melinda Maggard-Gibbons.
• Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
• Ann. Surg. 2018 Jul 1; 268 (1): 48-57.

ObjectiveThe aim of this study was to systematically review the risks and benefits of interventions designed to reduce intraoperative costs.Summary Background DataEpisode-based payments shift financial risk from insurers onto hospitals and providers. The operating room (OR) is a resource dense environment and there is growing interest in identifying ways to reduce intraoperative costs while maintaining patient safety.MethodsWe searched PubMed, Cochrane, and CINAHL for articles published between 2001 and March 2017 that assessed interventions designed to reduce intraoperative costs. We grouped interventions into 6 categories: standardization of instruments, switching to reusable instruments or removing instruments from trays, wound closure comparisons, cost feedback to surgeons, head-to-head instrument trials, and timely arrival of surgeon to the OR.ResultsOf 43 included studies, 12 were randomized trials and 31 were observational studies. Gross cost estimates ranged from -$413 (losses) to $3154 (savings) per operation, with only 2 studies reporting losses; however, studies had significant methodologic limitations related to cost data. Studies evaluating standardization and cost feedback were the most robust with estimated cost savings between $38 and $732/case, with no change in OR time, length of stay, or adverse events.ConclusionsAlmost all studies assessing interventions to reduce intraoperative costs have demonstrated cost savings with no apparent increase in adverse effects. Methodologic limitations, especially related to cost data, weaken the reliability of these estimates for most intervention categories. However, hospitals seeking to reduce costs may be able to do so safely by standardizing operative instruments or providing cost feedback to surgeons.

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