Variations in Stapes Surgery Cost within a Multihospital Network

• Published in: Otolaryngology-head and neck surgery Vol. 161; no. 5; pp. 835 - 841
• Main Authors: Casazza, Geoffrey C., Thomas, Andrew J., Dewey, Jesse, Gurgel, Richard K., Shelton, Clough, Meier, Jeremy D.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2019
• Subjects: Adult; Audiometry - economics; Cohort Studies; cost; Female; Health Care Costs; Humans; Laser Therapy - economics; Male; Middle Aged; Operative Time; otology; otosclerosis; Retrospective Studies; stapedectomy; stapedotomy; Stapes Surgery - education; otosclerosis; cost; otology; stapedotomy; stapedectomy
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599819855055

Objective
To identify costs and operative times for stapedotomy and evaluate factors influencing cost variation.
Study Design
Case series with cost analysis.
Setting
Multihospital network.
Subjects and Methods
A multihospital network’s standardized activity-based accounting system was used to determine costs and operative times of all patients undergoing stapedotomy from 2013 to 2017. Subjects with additional procedures were excluded. Correlations between variable factors and cost were calculated by Spearman correlation coefficients. Audiometric and cost data were compared with a Mann-Whitney U test.
Results
The study cohort included 176 stapedotomies performed by 23 surgeons at 10 hospitals. Mean ± SD patient age was 44.3 ± 17.4 years. Mean cut-to-close time was 61.1 ± 23.55 minutes. Mean total encounter cost was $3542.14 ± $1258.78 (US dollars). Significant factors correlating with increased total encounter cost were surgical supply cost (r = 0.74, P < .0001) and cut-to-close time (r = 0.66, P < .0001). Laser utilization ($563.37 ± $407.41) was the highest-cost surgical supply, with the carbon dioxide laser being significantly more costly than the potassium titanyl phosphate (KTP; $852.60 vs $230.55, P < .001). Additionally, the carbon dioxide laser was associated with a significantly higher mean total encounter cost than the KTP laser ($4645.43 vs $2903.00, P < .001) and cases where no laser was used ($4645.43 vs $2932.47, P < .001). There was no difference in mean total encounter cost between the KTP laser and cases of no laser use ($2903.00 vs $2932.47, P = .75).
Conclusions
Significant cost variation exists in stapes surgery. Surgical supply cost, specifically laser use, may be associated with significantly increased costs. Reducing variation in costs while maintaining outcomes may improve health care value.