Surgeon- and Hospital-Level Contributions to Surgical Supply Cost Variation in an Integrated Health System.
Publication/Presentation Date
7-27-2026
Abstract
BACKGROUND: Direct surgical supply costs are a modifiable component of operating room spending, but it is unclear whether variation reflects reproducible hospital- and surgeon-level practice patterns and whether stewardship opportunity is broadly distributed or concentrated.
STUDY DESIGN: Retrospective observational study of 298,723 operative encounters from April 1, 2019, to March 31, 2025, across 15 hospitals in a single integrated health system. Hierarchical mixed-effects linear regression modeled log supply cost per case with random intercepts for hospitals and surgeons nested within hospitals, adjusting for CPT3 procedural family, calendar year, COVID-era indicator, and, in a complete-case subset, operative duration. Modeled excess cost benchmarked adjusted supply costs to internally observed top-quartile performance within each CPT3 family.
RESULTS: In the baseline model (n = 298,723), hospital-level factors accounted for 35.4% and surgeon-within-hospital factors for 32.7% of total variance (cumulative intraclass correlation coefficient [ICC], 0.681). After operative time adjustment (n = 150,461), hospital variance was 38.1% and surgeon-within-hospital variance was 26.9% (cumulative ICC, 0.650). Benchmarking corresponded to a 20-25% reduction in mean supply cost per case, with approximately 62% persisting after time adjustment. Fewer than 15% of CPT3 families accounted for more than half of modeled opportunity, and the top 5% of surgeons accounted for 56.1% of modeled excess cost. Higher adjusted supply costs were not consistently associated with 30-day readmission (adjusted odds ratio per 1-SD increase, 1.03; 95% CI 0.97-1.09).
CONCLUSIONS: Surgical supply cost variation was reproducible, concentrated, and only partly explained by operative duration. These findings support targeted supply stewardship focused on high-impact procedure families and surgeons.
ISSN
1879-1190
Published In/Presented At
Dallal, R. M., Pribitkin, E. A., Zaki, R. F., & Yeo, C. J. (2026). Surgeon- and Hospital-Level Contributions to Surgical Supply Cost Variation in an Integrated Health System. Journal of the American College of Surgeons, 10.1097/XCS.0000000000002107. Advance online publication. https://doi.org/10.1097/XCS.0000000000002107
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42515818
Department(s)
Administration and Leadership
Document Type
Article