Unrecognized Costs in Computer-Assisted Surgery:
Equipment Malfunction and Repair
Several years ago, CAVA encountered a request from a hospital to evaluate costs that were not being fully represented in the financial analysis of each robotic surgical case. As a beginning robotic surgical program, scope repairs were frequent and reposable instrument dysfunction was high. The full breadth of the costs associated with the issue and the underlying factors influencing these events were unrecognized.
Together, we discovered that scope repair costs were underappreciated. Due to a multitude of factors including staff training, sterile processing and scope handling, the incidence of scope repair was much higher than anticipated. Scope repair provided by the vendor despite a maintenance contract approached $9k/incident and over $60,000/year!
Reposable malfunction was much more difficult to quantify, however. When an instrument malfunctioned, it was sent back to the vendor for evaluation. The vendor determined the reason for the malfunction and whether the unused “lives” of the reposable instrument remaining could be credited back to the hospital. In the cost accounting software and methodology of the hospital, keeping track of these incidents was challenging. However, CAVA’s analysis of the reasons for instrument failure revealed several things: surgeon error and potential internal collisions were frequently a cause of instrument malfunction as indicated by things such as fracture of the “shaft” of the instrument. Moreover, many of these events went unrecognized during the operation. Another cause was attributed to excessive or improper handling and processing of the reposable instruments. This brought to light important changes in turnover and sterile processing protocol that are important to maximizing the life of these reposables. Lastly, there were “unknown” factors in which a specific cause for instrument malfunction could not be found, including things like a cable being displaced, the instrument not responding well, and the scissors not cutting well.
CAVA’s advice: Avoid wracking-up unmonitored costs of computer-assisted surgery. Be sure to track your “under the radar” costs and repairs. More importantly, have processes in place such as handling of reposables and scopes in all departments (i.e., the operating room and sterile processing) because the financial consequences of unmonitored repair costs are significant.