Reducing Healthcare Costs Facilitated by Surgical Auditing: A Systematic Review

Reducing Healthcare Costs Facilitated by Surgical Auditing: A Systematic Review

Nama Jurnal	Judul Jurnal	Tahun Published	Pokok Bahasan	Summary / Kesimpulan	Saran
World Journal of Surgery	Reducing Healthcare Costs Facilitated by Surgical Auditing: A Systematic Review	2015	Many articles have been published describing a relationship between surgical auditing and quality improvement Goal in health care should be maximizing value for patients. The healthcare industry has been lagging behind regarding the availability of key data on process and outcomes of care, when compared to other industries where product evaluation is standardly embedded in the production process.	In this systematic review, a relationship between surgical auditing and reduced healthcare costs was identified. Though frequently assumed in the literature, only six articles actually described this relationship. All identified studies suggest that besides quality improvement, surgical auditing has the potential to reduce in-hospital costs. Surgical audits facilitate this process and, most important, surgical auditing might lead to improved outcomes for patients. Whether this involves orthopedic surgery [22], colorectal surgery [6], vascular surgery [16], or general surgery [9, 10, 17, 18], all show an association with improved clinical outcome. Because of the cost- and time-consuming exercise of data collection [23], the use of surgical auditing as a quality instrument will catalyze only when it proves to be cost-effective. Four of the identified articles [17, 18, 20, 21] incorporated costs of the audit itself in their calculations and therefore analyzed the actual costeffectiveness of surgical audits. These four studies showed larger reduction in costs (due to quality improvement) compared to the audit participation-costs, and therefore overall cost reduction was established. A factor that attributed to the high reduction in costs in this study might be the selection of colorectal cancer patients. In high-risk procedures, like colorectal cancer resections, the prevention of adverse events, such as anastomotic leakage, might be of greater clinical [24] and financial impact. Although we only identified articles focused on hospitalrelated costs, registries that cover the complete patient cycle should provide better insights. Long-term complications can be identified which might cover ‘hidden’ longterm costs. For example, in colorectal cancer surgery, the creation of a defunctioning stoma shortens length of hospital stay during the initial operation and lowers short-term complications [38]. However, next to the impact on quality of life a stoma has, it also has serious long-term financial implications. Patients have a life time need for colostomy pouches and a constant risk for long-term complications [39] which are seen in up to fifty percent of the patients within ten year follow up [40]. Increasing quality and reducing costs is the fundamental base of ‘value based health care’ [7]. Therefore, covering short- as well as long term outcomes should be aimed for all health care evaluations. While surgical auditing has become more  integrated in common practice, its effectiveness on costs needs to be evaluated as well, and perhaps costs evaluation has to be incorporated in the feedback mechanisms of the audit.	In future, widespread introduction and continuous use of surgical auditing is required to evaluate and improve quality of medical care for patients. The main focus should be evaluation of high-risk procedures since prevention of adverse events in these procedures will have greater clinical and financial impact compared to lowrisk procedures. Moreover, when financial outcomes are incorporated in the audit, calculating those financial outcomes should be based on actual costs, for example using time-driven activitybased costing. In the future, covering the complete cycle of care and incorporating cost analyses and patient related outcome measures would increase the audits’ value and provide a complete overview of the value of healthcare. Further studies describing the audit’s value should include all of the above-mentioned elements, in order to provide more robust evidence for further implementation of auditing