Surgeon education through a surgical cost feedback system reduces supply cost in endoscopic skull base surgery

Renuka K. Reddy, Amarbir S. Gill, Joshua Hwang, Machelle D. Wilson, Kiarash Shahlaie, Griffith R. Harsh IV, E. Bradley Strong, Toby O. Steele

Research output: Contribution to journalArticlepeer-review


OBJECTIVE A large proportion of healthcare expense is operating room (OR) costs. As a means of cost mitigation, several institutions have implemented surgeon education programs to bring awareness about supply costs. This study evaluates the impact of a surgical cost feedback system (surgical receipt) on the supply costs of endoscopic skull base surgery (ESBS) procedures. METHODS The supply costs of each ESBS surgical case were prospectively collected and analyzed before and after the implementation of a nonincentivized, automated, and itemized weekly surgical receipt system between January 2017 and December 2019. Supply cost data collected 15 months prior to intervention were compared with cost data 21 months after implementation of the surgical receipt system. Demographics, surgical details, and OR time were collected retrospectively. RESULTS Of 105 ESBS procedures analyzed, 36 preceded and 69 followed implementation of cost feedback. There were no significant differences in patient age (p = 0.064), sex (p = 0.489), surgical indication (p = 0.389), or OR anesthesia time (p = 0.51) for patients treated before and after implementation. The mean surgical supply cost decreased from $3824.41 to $3010.35 (p = 0.002) after implementation of receipt feedback. Usage of dural sealants (p = 0.043), microfibrillar collagen hemostat (p = 0.007), and oxidized regenerated cellulose hemostat (p < 0.0001) and reconstructive technique (p = 0.031) significantly affected cost. Mediation analysis confirmed that the overall cost reduction was predominantly driven by reduced use of dural sealant; this cost saving exceeded the incremental cost of greater use of packing materials such as microfibrillar collagen hemostat. CONCLUSIONS Education of surgeons regarding surgical supply costs by a surgical receipt feedback system can reduce the supply cost per case of ESBS operations.

Original languageEnglish (US)
Pages (from-to)422-430
Number of pages9
JournalJournal of Neurosurgery
Issue number2
StatePublished - Feb 2022


  • dural sealants
  • endoscopic skull base surgery
  • pituitary
  • supply cost
  • surgeon education
  • surgical receipt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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