General Session: Value and Outcomes in Spine Surgery

Presented by: J. Abrams - View Audio/Video Presentation (Members Only)

Author(s):

J. Abrams(1), M. Dekutoski(1), N. Chutkan(1)

(1) The Core Institute, Phoenix, AZ, United States

Abstract

Objectives: Contemporary models of Surgical CoManagement are based upon cost effective delivery of quality care by Surgeons and Hospitals. Vendors have, by tradition, played an independent role in this risk-sharing model. In a collaborative sustainable model, surgeons, vendors and operating room leaders are charged to optimize safe and cost effective surgical processes.
This study presents a collaborative effort by surgeon, vendor and hospital to improve operating room efficiencies in spine surgery. It is a single-institution, prospective and randomized review of spine surgeries completed before and after tray consolidation, analysis of procedural delays and operating room collaboration. Additionally, it presents a cost savings achieved after these modifications.

Methods: Operating room process data for 6 month time frames prior to and after the efficiency initiative were metriced to study impact on surgical procedural flow, efficiency and procedural cost data. All spine cases were reviewed with focus analysis on minimally invasive transforaminal interbody fusion (MIS-TLIF), lateral interbody fusion with posterior instrumentation (LLIF-P) and anterior interbody fusion with posterior fusion (ALIF-P). During the initial six-month data collection, 64 cases were tracked. For MIS-TLIF, LLIF-P and ALIF-P, trays were grossly consolidated from 16 trays to 4, 17 trays to 5 and 15 trays to 4, respectively.
After the initial six-month interval, additional perioperative delays and inefficiencies were found utilizing a data tracker. Strategies were made to synchronize start times, turnover benchmarks and establish nursing teams specific for spine surgery.
During the second six month data collection, after the operating room efficiencies and tray consolidation were performed, 85 cases were analyzed.

Results: With a hospital specific $125 per tray processing, Co-mangement impact results included: a cost savings of $1500 per case (MIS-TLIF), $1500 per case (LLIF-P) and $1350 per case (ALIF-F). For one surgeon, this equates to an annualized cos savings of $54,000 (MIS-TLIF), $60,000 (LLIF-P), and $82,500 (ALIF-P) for tray consolidation alone. Data Tracker post-improvements, recognized a reduction in per case time that averaged 52 minutes for twelve time stamps including operating room set up time, anesthesia time, cut to close, and clean down time. This included an 18-minute improved set up time, 17-minute clean down time, a 17-minute cut-to-close time.
Traditional operating room costs of $400/ten minutes equates to a $374000 (170x55x400/10) annual savings in hospital operating room costs.
A more theoretical total annualized impact of this project recognized a potential cost benefit of (374k +54k +60k+82.5k) $570,500

Conclusion: Procedural efficiency and significant cost reductions can be effected by collaborative attention to procedural flow, OR team feedback, documentation of procedural efficiency and instrument tray consolidation. Key terms: efficiency, operating room, cost reduction, tray consolidation, comanagement