Understanding the Costs of Surgery: A Bottom-Up Cost Analysis of Both a Hybrid Operating Room and Conventional Operating Room

Abstract

Background: Over the past decade, many hospitals have adopted hybrid operating rooms (ORs). As resources are limited, these ORs have to prove themselves in adding value. Current estimations on standard OR costs show great variety, while cost analyses of hybrid ORs are lacking. Therefore, this study aims to identify the cost drivers of a conventional and hybrid OR and take a first step in evaluating the added value of the hybrid OR. Methods: A comprehensive bottom-up cost analysis was conducted in five Dutch hospitals taking into account: construction, inventory, personnel and overhead costs by means of interviews and hospital specific data. The costs per minute for both ORs were calculated using the utilization rates of the ORs. Cost drivers were identified by sensitivity analyses. Results: The costs per minute for the conventional OR and the hybrid OR were €9.45 (€8.60-€10.23) and €19.88 (€16.10- €23.07), respectively. Total personnel and total inventory costs had most impact on the conventional OR costs. For the hybrid OR the costs were mostly driven by utilization rate, total inventory and construction costs. The results were incorporated in an open access calculation model to enable adjustment of the input parameters to a specific hospital or country setting. Conclusion: This study estimated a cost of €9.45 (€8.60-€10.23) and €19.88 (€16.10-€23.07) for the conventional and hybrid OR, respectively. The main factors influencing the OR costs are: total inventory costs, total construction costs, utilization rate, and total personnel costs. Our analysis can be used as a basis for future research focusing on evaluating value for money of this promising innovative OR. Furthermore, our results can inform surgeons, and decision and policy-makers in hospitals on the adoption and optimal utilization of new (hybrid) ORs.

Outcome and Cost Comparisons Between Surgical and Transcatheter Aortic Valve Replacements

“…A detailed 2020 Dutch analysis found costs per minute of a hybrid OR were double that of a conventional OR (€9.45 vs €19.88), driven by construction, inventory, personnel, and overhead costs. 27 Per-minute OR costs in this study were $198 for TAVR and $57 for SAVR in our series, much higher than per-minute OR costs published elsewhere. 27,28 OR costs at VA hospitals are bundled with anesthesia and perfusion costs, potentially explaining this discrepancy with other series.…”

A cost-effectiveness analysis of three approaches for lymph node assessment in patients with low- and intermediate-risk endometrial cancer

“…Surgery time was based on literature and expert opinion, while costs per minute surgery, including personnel, were based on a bottom-up cost analysis for operating rooms. [29,[32][33][34] Cost for external beam radiotherapy and vaginal brachytherapy were based on diagnosis treatment combination prices from the Dutch healthcare authority, whereas costs for chemotherapy were based on reference prices from the Dutch pharmacotherapeutic compass. [35] Cost for treatment of lymphedema and lymphocele were based on both initial and yearly treatment of stage II lower leg lymphedema.…”

Monitored Anesthesia Care Versus General Anesthesia for Transcatheter Aortic Valve Replacement

“…24 The high cost of a hybrid OR likely explains these findings, and the use of MAC may not have driven the savings. 35,36 A 2017 propensity-matched analysis found a 28% decrease in direct cost when MAC was used for TAVR. 25 However, this latter study was of high-risk patients, with a large percentage of cases done by transapical approach.…”