• Anaeze C Offodile, Aditi P Sen, Shelby Holtsmith, Jon Escalante, Anne Park, John Terrell, Roland Bassett, and Nancy D Perrier.
• Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX; Baker Institute for Public Policy, Rice University, Houston, TX.
• J. Am. Coll. Surg. 2020 Apr 1; 230 (4): 585-593.

BackgroundOperating room (OR) cost accounts for a significant portion of inpatient spending, but most surgeons are unaware of the costs of OR implants and supplies. We leveraged behavioral economics principles and a cost transparency tool to have an impact on discretionary OR spending (disposable supplies).Study DesignWe performed a single-institution, prospective study, from January to December 2018, across 3 departments: urology, thoracic, and endocrine. Two self-selected procedures per department were subjected to intraoperative supply cost (ISC) feedback via a custom dashboard and monthly email reports. Behavioral economics principles like choice overload, social ranking, and threshold effects were leveraged during study design. The primary outcome of percentage change in the department-level mean ISC, as determined via an interrupted time-series mixed effects model, was compared between the intervention year (2018) and "pre-baseline" (2016) and "baseline" (2017) years.ResultsA total of 2,853 procedures and 26 surgeons comprised our analytical sample. Costs decreased in 5 of the 6 procedures in 2018. On average, there was a significant monthly decrease in costs of approximately 0.5% over the study period (p = 0.0004). Post-intervention, there was a nonsignificant additional decrease of 0.6% in monthly cost (p = 0.0648). Overall cost significantly decreased by 20% due to the intervention (p < 0.0001). Similar results were noted on sensitivity analysis. There were no significant changes in the incidence of postoperative complication due to our intervention.ConclusionsDeployment of a cost feedback tool using behavioral economics principles resulted in a significant decrease in OR spending without negatively affecting complication rate.Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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