Reorganizing the system of care surrounding laparoscopic surgery: A cost-effectiveness analysis using discrete-event simulation

Purpose. To determine the cost-effectiveness of a proposed reorganization of surgical and anesthesia care to balance patient volume and safety. Methods. Discrete-event simulation methods were used to compare current surgical practice with a new modular system in which patient care is handed off between 2 anesthesiologists. A health care system's perspective, using hospital and professional costs, was chosen for the cost-effectiveness analysis. Outcomes were patient throughput, flow time, wait time, and resource use. Sensitivity analyses were performed on staffing levels, mortality rates, process times, and scheduled patient volume. Results. The new strategy was more effective (average 4.41 patients/d [median = 5] v. 4.29 [median = 4]) and had similar costs (average cost/patient/d = $5327 v. $5289) to the current strategy with an incremental cost-effectiveness of $318/additional patient treated/d. Surgical mortality rate must be >4% or hand-off delay >15 min before the new strategy is no longer more effective. Conclusion. The proposed system is more cost-effective relative to current practice over a wide range of mortality rates, hand-off times, and scheduled patient volumes.