Objectives: Identify costs and operative times for tympanoplasty, and evaluate factors influencing cost and time variation.
Study design: Retrospective cohort study.
Setting: Multihospital network.
Patients: Patients undergoing tympanoplasty from 2008 to 2016. Subjects with additional procedures were excluded.
Interventions: A multihospital network's standardized activity-based accounting system was used to determine costs and operative times of tympanoplasty.
Main outcome measures: Correlation between variable factors and cost was calculated by Spearman correlation coefficients. Statistical comparisons of cost and time were made between surgeons and hospitals using an ANOVA test (Kruskal-Wallis) followed by Dunn's test to correct for multiple comparisons. All providers or hospitals with single cases were excluded for statistical comparison.
Results: The study cohort included 487 tympanoplasties performed by 44 surgeons at 13 hospitals. Mean patient age was 18.2 ± 17.4 years. Mean cut-to-close time was 85.8 ± 56.7 minutes. Mean total encounter cost was $3491 ± $1,627. Substantial factors associated with total encounter cost were anesthesia cost (r = 0.8782; 95% CI 0.852-0.900, p < 0.001) and cut-to-close time (r = 0.7543; 95% CI 0.707-0.7949, p < 0.001). The total itemized supply cost was less correlated with total encounter cost (r = 0.3176; 95% CI 0.2128-0.4151, p < 0.001). Laser utilization (mean cost $541 ± $343) and artificial graft material (mean cost $199 ± $94) were the major supply costs.
Conclusion: Significant variation in tympanoplasty costs exists among different surgeons and hospitals within a multihospital network. Reducing variation in costs while maintaining outcomes may improve healthcare value and eliminate waste.