In combined colorectal/liver resection patients, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSIs, with the greatest impact on superficial/deep SSI, and modest reduction in LOS. The absence of trends within each time period indicated that the intervention was likely responsible for SSI reduction. Future efforts should target further reduction in organ space SSI.

Background: With the current emphasis on improving quality and cost reduction in medicine, it is imperative to critically evaluate cost-value relationships for surgical procedures. Previously our group had demonstrated comparable clinical outcomes, reduced length of stay (LOS) and reduced operative time for Laparoscopic Right Hepatectomy (LRH) compared to open right hepatectomy (ORH). Though the two groups had similar overall costs, intraoperative cost in the LRH group was higher. Methods: We decoded LRH into its component critical steps using value stream mapping (VSM), and analyzed the associated costs. We prospectively modified our surgical technique to target those steps that had high intraoperative costs (parenchymal transection, hemostasis) and measured the changes in outcomes. We reviewed medical records at our institution for patients who underwent elective LRH before (pre-LRH n = 22) and after (post-LRH n = 22) the intervention and those who had ORH (n = 65), between January 1, 2008 and November 30, 2016. Results: Average overall cost for the procedure was significantly lower for the post-standardization LRH group