• Nitin Agarwal, Prateek Agarwal, Ashley Querry, Anna Mazurkiewicz, Brittany Whiteside, Oscar C Marroquin, Stephen F Koscumb, Daniel A Wecht, and Robert M Friedlander.
• Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
• Neurosurgery. 2018 May 1; 82 (5): 661-669.

BackgroundStudies have demonstrated that physicians are often unaware of prescription drug, laboratory, diagnostic, and surgical supply costs.ObjectiveTo investigate the effects of increased physician awareness on infection incidence and surgical device cost containment.MethodsWithin our institution, physicians were informed of individual, independently adjudicated, craniotomy and ventricular shunt infection incidence and rankings among peers, after which a protocol aimed at reducing skin bacterial burden was implemented for craniotomies. Physicians were also made aware of the costs for shunts and dural substitutes as well as available alternatives.ResultsThe combined craniotomy and ventricular shunt infection incidence significantly decreased by 37.5% from 3.2% over May 2011 to April 2015 (132 infections/4137 procedures) to 2.1% over May 2015 to April 2016 (26 infections/1250 procedures; P = .041). The average annual cost savings was $234 175 from preventing postoperative craniotomy infections and $121 125 from preventing postoperative ventricular shunt infections. Total supply costs of ventricular shunts significantly decreased by 26% from $2345 per procedure in fiscal year 2015 to $1747 per procedure in fiscal year 2016 (P < .001). Total supply cost of dural grafts significantly decreased by 54% from $191 per procedure in fiscal year 2015 to $88 per procedure in fiscal year 2016 (P < .001). In total, all initiatives in this study resulted in an estimated annual savings of $567 062.ConclusionPhysician awareness of outcomes and costs resulted in increasing the quality of care, while at the same time reducing the cost.

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