Estimating surgical case durations and making comparisons among facilities: identifying facilities with lower anesthesia professional fees

Franklin Dexter; Richard H Epstein; Emine O Bayman; Johannes Ledolter

doi:10.1213/ANE.0b013e31828b3813

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Estimating surgical case durations and making comparisons among facilities: identifying facilities with lower anesthesia professional fees

Journal article

Open access

Peer reviewed

Estimating surgical case durations and making comparisons among facilities: identifying facilities with lower anesthesia professional fees

Franklin Dexter, Richard H Epstein, Emine O Bayman and Johannes Ledolter

Anesthesia and analgesia, Vol.116(5), pp.1103-1115

05/2013

DOI: 10.1213/ANE.0b013e31828b3813

PMID: 23558844

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https://doi.org/10.1213/ANE.0b013e31828b3813View

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Abstract

Consumer-driven health care relies on transparency in cost estimates for surgery, including anesthesia professional fees. Using systematic narrative review, we show that providing anesthesia costs requires that each facility (anesthesia group) estimate statistics, reasonably the mean and the 90% upper prediction limit of case durations by procedure. The prediction limits need to be calculated, for many procedures, using Bayesian methods based on the log-normal distribution. Insurers and/or governments lack scheduled durations and procedures and cannot practically infer these estimates because of the large heterogeneities among facilities in the means and coefficients of variation of durations. Consequently, the insurance industry cannot provide the cost information accurately from public and private databases. Instead, the role of insurers and/or governments can be to identify facilities with significantly briefer durations (costs to the patient) than average. Such comparisons of durations among facilities should be performed with correction for the effects of the multiple comparisons. Our review also has direct implications to the potentially more important issue of how to study the association between anesthetic durations and patient morbidity and mortality. When pooling duration data among facilities, both the large heterogeneity in the means and coefficients of variation of durations among facilities need to be considered (e.g., using "multilevel" or "hierarchical" models).

Postoperative Complications - economics

Confidence Intervals

Data Interpretation, Statistical

Health Facilities - statistics & numerical data

Hospital Mortality

Humans

General Surgery - economics

Anesthesia - statistics & numerical data

Anesthesia - economics

Health Facilities - economics

Postoperative Complications - epidemiology

Models, Economic

Postoperative Complications - mortality

General Surgery - organization & administration

Forecasting

Bayes Theorem

Fees, Medical - statistics & numerical data

Insurance, Health

Details

Title: Subtitle: Estimating surgical case durations and making comparisons among facilities: identifying facilities with lower anesthesia professional fees
Creators: Franklin Dexter - Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa 52242, USA. Franklin-Dexter@UIowa.ed
Richard H Epstein
Emine O Bayman
Johannes Ledolter
Resource Type: Journal article
Publication Details: Anesthesia and analgesia, Vol.116(5), pp.1103-1115
Publisher: United States
DOI: 10.1213/ANE.0b013e31828b3813
PMID: 23558844
ISSN: 0003-2999
eISSN: 1526-7598
Language: English
Date published: 05/2013
Academic Unit: Statistics and Actuarial Science; Health Management and Policy; Biostatistics; Anesthesia; Business Analytics
Record Identifier: 9983806276302771

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