Overlapping surgery remains a controversial topic in the medical community. Although numerous studies have examined the safety profile of overlapping operations, there are few data on its financial impact. The authors assessed direct hospital costs associated with neurosurgical operations during periods before and after a more stringent overlapping surgery policy was implemented.
The authors retrospectively reviewed the records of nonemergency neurosurgical operations that took place during the periods from June 1, 2014, to October 31, 2014 (pre–policy change), and from June 1, 2016, to October 31, 2016 (post–policy change), by any of the 4 senior neurosurgeons authorized to perform overlapping cases during both periods. Cost data as well as demographic, surgical, and hospitalization-related variables were obtained from an institutional tool, the Value-Driven Outcomes database.
A total of 625 hospitalizations met inclusion criteria for cost analysis; of these, 362 occurred prior to the policy change and 263 occurred after the change. All costs were reported as a proportion of the average total hospitalization cost for the entire cohort. There was no significant difference in mean total hospital costs between the prechange and postchange period (0.994 ± 1.237 vs 1.009 ± 0.994, p = 0.873). On multivariate linear regression analysis, neither the policy change (p = 0.582) nor the use of overlapping surgery (p = 0.273) was significantly associated with higher total hospital costs.
A more restrictive overlapping surgery policy was not associated with a reduction in the direct costs of hospitalization for neurosurgical procedures.
ABBREVIATIONSASA = American Society of Anesthesiologists; VDO = Value-Driven Outcomes.
Correspondence Richard H. Schmidt: University of Utah, Salt Lake City, UT. firstname.lastname@example.org.
INCLUDE WHEN CITING Published online September 28, 2018; DOI: 10.3171/2018.5.JNS18569.
Disclosures Dr. Jensen: consultant for Medtronic; and advisory boards for Pharmaco-Kinesis and Varian. Dr. Dailey: consultant for Medtronic, K2M, and Zimmer-Biomet; speaking fees from AONA; and support of non–study-related clinical or research effort from K2M. Dr. Bisson: consultant for nView.
AlanNSeiceanASeiceanSNeuhauserDBenzelECWeilRJ: Preoperative steroid use and the incidence of perioperative complications in patients undergoing craniotomy for definitive resection of a malignant brain tumor. J Clin Neurosci22:1413–14192015
American Association of Neurological Surgeons: Position statement on intraoperative responsibility of the primary neurosurgeon. AANS.org. (http://www.aans.org/pdf/Legislative/Neurosurgery%20Position%20Statement%20on%20Overlapping%20Surgery%20FINAL.pdf) [Accessed on June 25 2018]
DimickJBChenSLTaheriPAHendersonWGKhuriSFCampbellDAJr: Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg199:531–5372004
GuanJKarsyMBrockACouldwellWKestleJJensenR: Impact of a more restrictive overlapping surgery policy: an analysis of pre- and postimplementation complication rates, resident involvement, and surgical wait times at a high-volume neurosurgical department. J Neurosurg[epub ahead of print November 3 2017; DOI: 10.3171/2017.5.JNS17183]
LeeVSKawamotoKHessRParkCYoungJHunterC: Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. JAMA316:1061–10722016
MurphyCCIncalcaterraJRAlbrightHWCorreaAMSwisherSGHofstetterWL: Pretreatment patient comorbidity and tobacco use increase cost and risk of postoperative complications after esophagectomy at a high-volume cancer center. J Oncol Pract9:233–2392013
RaviBPincusDWassersteinDGovindarajanAHuangAAustinPC: association of overlapping surgery with increased risk for complications following hip surgery: a population-based, matched cohort study. JAMA Intern Med178:75–832018
U.S. Senate Committee on Finance: Concurrent and Overlapping Surgeries: Additional Measures Warranted. Washington, DC: U.S. Senate2016. (http://www.finance.senate.gov/imo/media/doc/Concurrent%20Surgeries%20Report%20Final.pdf) [Accessed on June 25 2018]