Evidence map›Paper›PMID 33718078›Full record

ArticleTranslational andrology and urology2021

Evaluating the impact of surgical supply cost variation during partial nephrectomy on patient outcomes.

Ashwin S Balakrishnan, Lindsay A Hampson, Alexander M Bell, Arthur H Baghdanian, Armonde A Baghdanian, Maxwell V Meng, Anobel Y Odisho

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Article in Translational andrology and urology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

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2citing papers in PubMed, 1 pooled it
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Ashwin S BalakrishnanDepartment of Urology, University of California, San Francisco, CA, USA.
Lindsay A HampsonDepartment of Urology, University of California, San Francisco, CA, USA.
Alexander M BellDepartment of Urology, University of California, San Francisco, CA, USA.
Arthur H BaghdanianDepartment of Radiology, University of Southern California, Los Angeles, CA, USA.
Armonde A BaghdanianDepartment of Radiology, University of Southern California, Los Angeles, CA, USA.
Maxwell V MengDepartment of Urology, University of California, San Francisco, CA, USA.
Anobel Y OdishoDepartment of Urology, University of California, San Francisco, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundReducing surgical supply costs can help to lower hospital expenditures. We aimed to evaluate whether variation in supply costs between urologic surgeons performing both robotic or open partial nephrectomies is associated with differential patient outcomes.

methodsIn this retrospective cohort study, we reviewed 399 consecutive robotic (n=220) and open (n=179) partial nephrectomies performed at an academic center. Surgical supply costs were determined at the institution-negotiated rate. Through retrospective review, we identified factors related to case complexity, patient comorbidity, and perioperative outcomes. Two radiologists assigned nephrometry scores to grade tumor complexity. We created univariate and multivariable models for predictors of supply costs, length of stay, and change in serum creatinine.

resultsMedian supply cost was $3,201 [interquartile range (IQR): $2,201-3,808] for robotic partial nephrectomy and $968 (IQR: $819-1,772) for open partial nephrectomy. Mean nephrometry score was 7.0 (SD =1.7) for robotic procedures and 8.2 (SD =1.6) for open procedures. In multivariable models, the surgeon was the primary significant predictor of variation in surgical supply costs for both procedure types. In multivariable mixed-effects analysis with surgeon as a random effect, supply cost was not a significant predictor of change in serum creatinine for robotic or open procedures. Supply cost was not a statistically significant predictor of length of stay for the open procedure. Supply cost was a significant predictor of longer length of stay for the robotic procedure, however it was not a clinically meaningful change in length of stay (0.02 days per $100 in supply costs).

conclusionsHigher supply spending did not predict significantly improved patient outcomes. Variability in surgeon supply preference is the likely source of variability in supply cost. These data suggest that efforts to promote cost-effective utilization and standardization of supplies in partial nephrectomy could help reduce costs without harming patients.

Indexed as

Cost analysispartial nephrectomyquality improvementsurgical suppliesurologic oncology

Identifiers

PMID33718078
PMCPMC7947437

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