Using Flexible Regimentation to Standardize Surgical Technique and the Impact on Supply Cost and Operation Time in Laparoscopic Appendectomy

Introduction: Laparoscopic appendectomy is a common procedure with variable supply costs that do not necessarily correlate with outcomes. The aim of this study was to evaluate the impact of using less expensive supplies on supply costs, operation times, and operation outcomes and describe how such changes can be introduced and disseminated. Methods: The Model for Improvement was used to drive the improvements described. Process mapping and flexible regimentation were used to determine which appendectomy steps could be standardized. Supply costs, operation times and outcomes were evaluated for all patients who underwent uncomplicated laparoscopic appendectomy by a single surgeon before and after the implementation of a lower supply cost preference card. Our aim was to decrease supply costs for laparoscopic appendectomy by 50% at a free-standing children’s hospital within one year. Results: Sixty-three patients underwent laparoscopic appendectomy for uncomplicated (nonperforated) appendicitis by the selected surgeon over the one-year study period. Supply costs decreased from approximately $2,000 to $1,000 per case and subsequently to approximately $250 per case, with no initial explanation for the stepwise decrease and no change in complications or operative time. Subsequent investigations using statistical process control revealed systemic discrepancies in the supply charge entry process secondary to COVID-19-related delays in system updates. Conclusions: Using less expensive supplies in laparoscopic appendectomy decreased costs with no negative impact on operation time or outcomes. Careful assessment of the data revealed systemic improvement opportunities.