The impact of surgeon choices on costs associated with uncomplicated minimally invasive colectomy: you are not as important as you think

BACKGROUND: There is increasing public discussion about the escalating cost of healthcare in America. There are no published data regarding the contribution of individual surgeons’ choices on the cost of uncomplicated minimally invasive colectomy. METHODS: A review of a hospital cost-accounting database of the direct costs related to the index operation and post-operative care of all patients who underwent elective minimally invasive segmental colectomy over a 1-year period was performed. RESULTS: A total of 111 cases were enrolled in this study, 18 of which were performed robotically. The average direct cost after minimally invasive colectomy was $5536. The cost of robotic colectomy was 53% greater than laparoscopic ($7806 vs $5096, p < 0.001). There was no statistically significant difference in overall costs among laparoscopic cases performed by three surgeons ($5099 vs $5108 vs $5055, p = 0.987). Average operating room supply costs among the three surgeons were $1236, $1105 and $1030, respectively (p = 0.067), with a standard deviation of $328 (6.4% of overall cost). CONCLUSIONS: No significant difference in overall costs between surgeons was demonstrated despite varied training, experience levels and operative techniques. Total costs are relatively institutionally fixed and minimally influenced by variations in individual surgeon preferences.