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Surgical scorecards may cut cost of surgical procedures without impacting outcomes

Providing surgeons with direct feedback by summarizing cost-per-operation may lower surgical procedure expenses, a major driver of healthcare costs

( Key takeaways 

A tool for evaluating the overall cost of a surgical procedure, called a scorecard, helps reduce costs of surgical procedures between 5% and 20% without adversely affecting clinical outcomes.   Further implementation of scorecards may move surgeons toward energy-efficient operating rooms, which are the largest hospital producer of emissions and waste.    CHICAGO (October 3, 2023): Surgical scorecards, a tool that gives direct feedback to surgeons about their procedure costs in the operating room, may significantly reduce costs without impacting clinical outcomes, according to a study published in the Journal of the American College of Surgeons (JACS). 

The surgical scorecard is a novel approach to addressing operating room costs. It is commonly delivered to the surgeon in the form of an email receipt, report card, or informational session summarizing the cost of their own surgical items, staffing, and the time used for any procedure in the operating room, as well as how those costs compare to colleagues’ costs and similar operations performed.   

“The reality is that healthcare in the United States is exorbitantly expensive, and despite this increased spending, Americans don’t have better health outcomes than our high income country neighbors,” said lead study author Wesley Dixon, MD, an internal medicine resident physician at Brigham and Women’s Hospital in Boston, Massachusetts. “Our results show that scorecard implementation is one of many different methods that can be used to lower health-care costs, particularly operating room costs, which comprise a significant proportion of health-care spending. Using different cost saving interventions together can reduce overall U.S. health care spending without compromising patient care.”   

Study design 

The researchers carried out a scoping review, which synthesizes all available study results based on keyword searches, by scanning research databases such as PubMed, Embase, and Web of Science to gather more information about surgical scorecards and their impact on cost reduction. 

Twenty-one studies published between 2011 and 2022 were included, spanning eight subspecialties and 30 procedures. Through a literature search, key elements of cost such as “surgical supplies,” “implants,” “wasted supplies,” and “operative time” were identified.  

The data was then analyzed according to the impact of scorecards on the percentage change in cost per operation – from before the intervention to after the intervention, and the impact on patient outcomes, which included operative time, postoperative length of stay, complication rates, readmission rates, and mortality.   

Key findings 

Of 30 total scorecard interventions measured across 21 studies, 16 out of 30 (53%) interventions showed surgical procedure cost reductions between 5% and 20%.   For 11 studies, cost reduction was attributed to reduced use of specific high cost items. Cost savings can come from using less expensive alternatives or wasting fewer supplies (opened but unused during the operation).   The most common surgical subspecialties included in the review were orthopedic and general surgery. A wide variety of procedures were included, but the most common were adult and pediatric laparoscopic appendectomy.   Making hospitals more energy efficient 

“The biggest knowledge gap we identified in this study is that there is essentially no research connecting surgical scorecards to surgeons with environmental or emissions data related to the operating room,” Dr. Dixon said.  

“Operating rooms contribute around 50% of hospital waste and are much more energy-intensive than the rest of the hospital, adding to the overall carbon footprint. Therefore, some of these data-driven feedback mechanisms that include carbon-related data would be a major step towards making the hospital a more energy-efficient place.” 

A limitation of the study is that a large part of scorecard use nationwide is implemented as part of quality improvement initiatives and those results are not always published. Therefore, the results of this scoping review might underrepresent the true impact of surgical scorecards.  

Study coauthors are Allan Ndovu; Millis Faust, MD; Tejas Sathe, MD; Christy Boscardin, PhD; Garrett R. Roll, MD, FACS; Kaiyi Wang, MS; and Seema Gandhi, MD. 

The study authors have no disclosures. 

This study is published as an article in press on the JACS website. 

Citation: Cost-Saving in the Operating Room: A Scoping Review of Surgical Scorecards. Journal of the American College of Surgeons. DOI:10.1097/XCS.0000000000000846 

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About the American College of Surgeons 

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 88,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons. 



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[] Surgical scorecards may cut cost of surgical procedures without impacting outcomes
Providing surgeons with direct feedback by summarizing cost-per-operation may lower surgical procedure expenses, a major driver of healthcare costs