The Relationship Between Surgeon Technical Skill and Healthcare Costs in Partial Nephrectomy

Introduction: There has been increasing interest in assessing the surgical performance of practicing surgeons. There is a growing body of literature linking a surgeon’s technical skill to short-term post-operative complications. However, little research has been performed examining technical skill and patient safety, and no research has examined the relationship between technical performance and hospital cost. The primary purpose of this thesis is to determine the relationship between direct, 30-day hospital costs and surgeon technical skill in open and robotic partial nephrectomy. Methods: We performed four studies: a systematic review examining the literature on intraoperative adverse events and costs, a prospective, multicenter, multi-surgeon study examining the relationship between direct, 30-day hospital costs and surgeon technical skill, and a prospective, multicenter, multi-surgeon study comparing the rates of intraoperative events between open and robotic partial nephrectomy. Finally, we performed a cost utility analysis to compare the cost effectiveness of open partial nephrectomy to robotic partial nephrectomy. Results: Four research studies were completed. Our systematic review found that while the overall quality of the current literature was poor, intraoperative events increase the cost of abdominal surgery. For our surgical safety study, open partial nephrectomy has a greater number of severe intraoperative events than robotic partial nephrectomy. When comparing the costs between surgeons of differing skill levels, surgeons with higher levels of technical skill cost less than surgeons with lower levels of skill. Finally, at a Willingness to Pay (WTP) of $200,000/QALY, open partial nephrectomy is the most cost effective option, although robotic partial nephrectomy becomes cost effective when the fixed robotic costs are below $3,330 per case. Conclusion: We are the first to study the relationship between surgeon performance and short-term hospital costs. While future studies need to confirm our findings, our results highlight the possibility of financial benefit from improving surgeon performance. Furthermore, we conclude that the robotic platform may improve intraoperative patient safety and intraoperative event assessment may be useful in providing individualized feedback.Ph.D