Microsurgery costs and outcome

Reliable information on cost and value in microsurgery is not readily avail able in the literature. Driving factors for cost, determinants of complicat ions, and cost-reduction strategies have not been elucidated in this popula tion, despite such progress in other areas of medicine. Clearly, the time-c onsuming and costly nature of this endeavor demands that appropriate indica tions and patient management be delineated; to operate preactively in this cost-conscious time, financial and outcome determinations are critical. One hundred seven consecutive free-tissue transfers performed from 1991 to 199 4 by a single microsurgeon were studied. Retrospective chart review for cli nical parameters was combined with analysis of hospital costs and professio nal charges. Operating room and anesthesia costs were based on a microcost analysis of actual operating room time, materials, labor, and overhead. Oth er patient level costs were generated by Transition 1, a hospital cost-acco unting system. The following issues were addressed: (1) flap survival; (2) total costs and length of stay for all free flaps; (3) payments received fr om various insurers; (4) breakdown of operating room costs by labor, suppli es, and overhead; (5) breakdown of inpatient costs by category; (6) additio nal costs of complications and takebacks; (7) factors associated with compl ications and flap takebacks; and (8) cost-reduction strategies. Mean free f lap operating room costs (exclusive of professional fees) ranged among case types from $4439 to $6856 and were primarily a function of operating room times. Elective patient cases lasted a mean 440 minutes. There was a large disparity in reimbursement: private insurers covered hospital costs (not ch arges) completely, whereas Medicare paid 79 percent and Medicaid only 64 pe rcent. Length of stay, operative procedures, and complications had the grea test influence on inpatient costs in this group of free flap patients. Pote ntial cost savings as a result of possible practice changes (e.g., shorteni ng intensive care unit stays and avoiding staged operations) can be predict ed. This analysis has caused a revision in these institutions' practice pat terns and lays the foundation for planned outcome studies in this populatio n.