<div class="section">
<a class="named-anchor" id="ab-soi170128-1">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e233">Importance</h5>
<p id="d1554381e235">Increasing value requires improving quality or decreasing costs.
In surgery, estimates
for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists
for the cost of OR time, nor has there been a comprehensive assessment of what contributes
to OR cost.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-soi170128-2">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e238">Objectives</h5>
<p id="d1554381e240">To calculate the cost of 1 minute of OR time, assess cost by
setting and facility
characteristics, and ascertain the proportion of costs that are direct and indirect.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-soi170128-3">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e243">Design, Setting, and Participants</h5>
<p id="d1554381e245">This cross-sectional and longitudinal analysis examined annual
financial disclosure
documents from all comparable short-term general and specialty care hospitals in California
from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused
on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-soi170128-4">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e248">Main Outcomes and Measures</h5>
<p id="d1554381e250">Mean cost of 1 minute of OR time, stratified by setting (inpatient
vs ambulatory),
teaching status, and hospital ownership. The proportion of cost attributable to indirect
and direct expenses was identified; direct expenses were further divided into salary,
benefits, supplies, and other direct expenses.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-soi170128-5">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e253">Results</h5>
<p id="d1554381e255">In FY2014, a total of 175 of 302 facilities (57.9%) were not
for profit, 78 (25.8%)
were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were
teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals
was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory
setting (
<i>P</i> = .65). There were no differences in mean expenditures when stratifying by
ownership
or teaching status except that teaching hospitals had lower mean (SD) expenditures
than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43];
<i>P</i> = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of
$37.37)
in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory
setting. Wages and benefits accounted for approximately two-thirds of direct expenses
(inpatient, $14.00 of $20.40; ambulatory, $14.35 of $20.90), with nonbillable supplies
accounting for less than 10% of total expenses (inpatient, $2.55 of $37.37; ambulatory,
$3.33 of $35.39). From FY2005 to FY2014, expenses in the OR have increased faster
than the consumer price index and medical consumer price index. Teaching hospitals
had slower growth in costs than nonteaching hospitals. Over time, the proportion of
expenses dedicated to indirect costs has increased, while the proportion attributable
to salary and supplies has decreased.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-soi170128-6">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e264">Conclusions and Relevance</h5>
<p id="d1554381e266">The mean cost of OR time is $36 to $37 per minute, using financial
data from California’s
short-term general and specialty hospitals in FY2014. These statewide data provide
a generalizable benchmark for the value of OR time. Furthermore, understanding the
composition of costs will allow those interested in value improvement to identify
high-yield targets.
</p>
</div><p class="first" id="d1554381e269">This cross-sectional analysis of annual financial
disclosure documents calculates
the cost of 1 minute of operating room time, assesses cost by setting and facility
characteristics, and ascertains the proportion of costs that are direct and indirect.
</p><div class="section">
<a class="named-anchor" id="ab-soi170128-7">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e275">Questions</h5>
<p id="d1554381e277">What is the cost of 1 minute of operating room time, and what
contributes to this
cost?
</p>
</div><div class="section">
<a class="named-anchor" id="ab-soi170128-8">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e280">Findings</h5>
<p id="d1554381e282">In this cross-sectional analysis, the mean cost of operating
room time in fiscal year
2014 for California’s acute care hospitals was $36 to $37 per minute; $20 to $21 of
this amount is direct cost, with $13 to $14 attributable to wages and benefits and
$2.50 to $3.50 attributable to surgical supplies.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-soi170128-9">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d1554381e285">Meaning</h5>
<p id="d1554381e287">These numbers are the first standardized estimates of operating
room cost; understanding
the composition of costs will allow those interested in value improvement to identify
high-yield targets.
</p>
</div>