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Anesthesiology:
Clinical Investigation

Where Are the Costs in Perioperative Care?: Analysis of Hospital Costs and Charges for Inpatient Surgical Care

Macario, Alex MD, MBA; Vitez, Terry S. MD; Dunn, Brian BA; McDonald, Tom MD

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Abstract

Background: Many health‐care institutions are emphasizing cost reduction programs as a primary tool for managing profitability. The goal of this study was to elucidate the proportion of anesthesia costs relative to perioperative costs as determined by charges and actual costs.
Methods: Costs and charges for 715 inpatients undergoing either discectomy (n = 234), prostatectomy (n = 152), appendectomy (n = 122) or laparoscopic cholecystectomy (n = 207) were retrospectively analyzed at Stanford University Medical Center from September 1993 to September 1994. Total hospital costs were separated into 11 hospital departments. Cost‐to‐charge ratios were calculated for each surgical procedure and hospital department. Hospitalization costs were also divided into variable and fixed costs (costs that do and do not change with patient volume). Costs were further partitioned into direct and indirect costs (costs that can and cannot be linked directly to a patient).
Results: Forty‐nine (49%) percent of total hospital costs were variable costs. Fifty‐seven (57%) percent were direct costs. The largest hospital cost category was the operating room (33%) followed by the patient ward (31%). Intraoperative anesthesia costs were 5.6% of the total hospital cost. The overall cost‐to‐charge ratio (0.42) was constant between operations. Cost‐to‐charge ratios varied threefold among hospital departments. Patient charges overestimated resource consumption in some hospital departments (anesthesia) and underestimated resource consumption in others (ward).
Conclusions: Anesthesia comprises 5.6% of perioperative costs. The influence of anesthesia practice patterns on "downstream" events that influence costs of hospitalization requires further study.
MANY health‐care institutions are emphasizing cost reduction programs as a primary tool for managing profitability. Services related to surgery can represent more than 40% of hospital costs and revenues.* Knowing the actual costs of providing care to surgical patients will assist hospital managers in developing targets for reduction and improving usage of health‐care resources. [1] Although reducing anesthesia costs may lead to savings, [2–8] the relative contribution of anesthesia costs to total perioperative costs is uncertain. [9].
Analysts often use patient charges to approximate costs. [10–16] The rationale behind this strategy involves: (1) hospital charges are more accessible than true costs; and (2) charges are believed to be related to costs by a constant correction factor‐‐the cost‐to‐charge ratio. However, basing an economic analysis on charges alone is known to lead to misleading results. [17–19] The goal of this study was to elucidate the proportion of anesthesia costs relative to the major hospital departments involved in surgical care and to explore the cost‐to‐charge relationship in perioperative care.
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Methods and Materials

Surgical Procedures
This retrospective study was approved by the institution's Human Subjects Committee. We selected four in‐patient surgical procedures: (1) intervertebral disc excision (discectomy); (2) retropubic or radical prostatectomy (prostatectomy); (3) appendectomy; and (4) laparoscopic cholecystectomy. These procedures were chosen because they represent common, nontertiary operations that may require a range of hospital resources.
We used International Classification of Diseases, 9th Revision, Clinical Modification (ICD‐9‐CM) procedure numbers 80.51 (discectomy, n = 234 patients), 60.4–60.5 (prostatectomy, n = 152 patients), 47.0 (appendectomy, n = 122 patients), and 51.23 (laparoscopic cholecystectomy, n = 207 patients) to retrieve hospital cost data for all 715 patients undergoing one of the four procedures between September 1993 and September 1994. Patients with other ICD‐9‐CM codes as principal procedures were excluded. Data were analyzed for each patient, by surgical procedure, and then in the aggregate for all patients. All patients underwent surgery at Stanford University Medical Center.
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Cost Data Source
Cost data were obtained from Stanford's integrated hospital cost management and decision system software (Transition Systems Inc., Boston, MA; TSI). The TSI software was developed at the New England Medical Center in the 1980s and has been implemented in more than 100 hospitals in the United States and in Europe. The TSI system acquires data from the hospital's existing data management systems, including clinical and financial transactions systems.
The TSI system divides costs into various categories based on the information available in the hospital's information systems. Clinical and financial data are combined to determine actual supply costs, compensation rates, and labor effort as measured by hospital department managers. TSI cost standards are continuously tested for accuracy and calibrated to actual expenses and revenues. All labor costs (e.g., nursing, technician, house staff) are included except for physician professional fees.
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Total Costs
The total hospital cost for each patient and for each operation was separated into 11 hospital departments: operating room, ward, surgery admission unit, post‐anesthesia care unit, anesthesia, laboratory, pharmacy, intensive care unit, blood blank (blood), radiology, and miscellaneous. Operating room costs include all equipment, labor, and supplies used once the patient entered the operating room. Ward costs reflect nursing density and the room and board function of the patient ward. The miscellaneous category included costs of occupational and physical therapy, emergency room, ambulatory treatment unit, endoscopy, and dietary services. Using patient‐specific data, detailed resource consumption profiles were established for each of the 11 hospital departments.
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Anesthesia Costs
Anesthetics were delivered by staff anesthesiologists and anesthesia house staff. All medications and supplies used to anesthetize each patient were recorded and included in the "anesthesia" hospital department. Examples of these costs were all airway supplies (e.g., endotracheal tube), intravenous and blood administration supplies (e.g., blood pump intravenous tubing), invasive pressure monitoring (e.g., transducers), regional anesthesia supplies (e.g., epidural kit), and salaries of anesthesia technicians. The professional fees of anesthesiologists (and all other attending staff) were excluded. Fixed costs such as the depreciation of the anesthesia machine were also used to calculate total costs.
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Classification of Costs
Variable and Fixed Costs. Total costs for each of the 11 hospital departments were separated into variable and fixed components. Variable costs change in direct proportion to volume; fixed costs remain unchanged despite changes in volume. [20].
Direct and Indirect Costs. Costs were also partitioned into direct and indirect components. Direct costs could be identified specifically with a patient care service. Indirect costs, conversely, are not directly related to individual patients but are incurred to support the clinical service.
Using the categories described earlier, costs were arranged into four subcategories: variable direct, variable indirect, fixed direct, and fixed indirect.
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Variable Direct Costs
Variable direct costs were defined as labor and supplies directly involved in producing a specific patient service. Examples include operating room personnel and supply costs required to deliver an anesthetic or nursing labor and medical supply expenses used to produce a patient day with 6 h of nursing care. Variable direct costs may reflect costs controlled by physicians' clinical decision‐making because neither fixed costs nor overhead costs are included in the variable direct cost category. The total variable direct cost attributed to a specific hospital unit (e.g., postanesthesia care unit) for a given patient was the sum of all the variable direct costs required to provide that service to the patient.
Variable Indirect Costs. Variable indirect costs were support costs driven by the level of service provided. Salaries for workers in Dietary or filing personnel in Medical Records are examples of variable indirect costs.
Fixed Direct and Indirect Costs. Fixed costs were allocated to the production of a patient service. Unit clerks and telephone expenses on nursing units are examples of fixed direct costs. Conversely, if a cost could not be linked with a particular patient, it was considered a fixed indirect cost (e.g., administration). As another example, a department's allocated depreciation expense was calculated from the square footage it occupied.
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Cost‐to‐charge Ratios
We also collected hospital bill charges for each patient. For each surgical procedure, an overall cost‐to‐charge ratio was calculated by dividing total hospitalization costs for all patients by the corresponding charges. Cost‐to‐charge ratios were also obtained for each of the 11 hospital departments.
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Statistics and Data Management
Data management and calculations were performed on Excel 4.0. (Microsoft Corporation, Redmond, WA) The proportion of hospital costs accounted for by each department were calculated by dividing the sum of department (e.g., anesthesia) costs for all patients by the sum of each patient's total costs. Ninety‐five percent confidence intervals (95% CI) for these proportions (ratio of mean values of two random variables) were obtained with Fieller's Theorem. [21] Analysis of variance with the Bonferroni method was used to describe statistical significance for cost‐to‐charge ratios among hospital departments and for percentages of total departmental costs due to variable direct costs. [22] Follow‐up comparisons were performed with t tests. Cost and charge data for patients were compared using the Wilcoxon signed‐rank test. Cost‐to‐charge ratios and variable direct cost to total cost percentages are presented as mean plus/minus one standard deviation.
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Results

Total Costs
Variable direct costs accounted for 44% of the total cost of hospitalization. Fixed indirect cost were 38% of total costs and fixed direct costs accounted for 13% of total costs. The remaining 5% of costs were variable indirect costs.
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Distribution of Total Costs by Hospital Department
Figure 1
Figure 1
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When using actual cost data, intraoperative anesthesia costs as a percentage of the total hospital cost equaled 5.6% (plus/minus 0.7%, 95% CI plus/minus 1.4%). The largest hospital cost category was the operating room (33% plus/minus 0.2%, 95% CI plus/minus 0.4%). Costs attributed to the patient ward equaled 31% (plus/minus 0.1%, 95% CI plus/minus 0.2%). Postanesthesia care unit costs were 3.7% (plus/minus 0.96%, 95% CI plus/minus 2.0%) of the total perioperative cost. The relative contribution of each hospital department to total cost varied among procedures (Figure 1).
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Costs Versus Charges
The ranking of the relative contribution of the hospital departments using charge data was similar to that for cost data. However, the actual percentages attributed to the hospital departments were different than when calculated with cost data. There was no consistent pattern to the differences.
Figure 2
Figure 2
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Figure 3
Figure 3
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Patient charges resulted in a 23% relative underestimate of the percentage of hospital resources utilized in delivering postoperative ward care (P < 0.001; Figure 2). In contrast, patient charges resulted in a 48% relative overestimate of actual anesthesia costs (P < 0.001; Figure 3). In absolute terms, charge analysis overestimated operating room costs as a fraction of total hospital costs for laparoscopic cholecystectomy (41.7% of total charges vs. 37.2% of total costs; P < 0.001). Charge analysis underestimated operating room costs for discectomy (33.6% of total charges vs. 39.2% of total costs; P < 0.001). For appendectomy and prostatectomy, charge data analysis resulted in negligible differences with actual cost analysis when estimating operating room costs as a fraction of total hospital costs.
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Overall Cost‐to‐charge Ratio
Dividing all hospital costs by all patient charges produced an overall cost‐to‐charge ratio of 0.42 (plus/minus 0.01). Overall cost‐to‐charge ratios were constant among operations.
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Cost‐to‐charge Ratios Vary Among Hospital Departments
Table 1
Table 1
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Cost‐to‐charge ratios for each hospital department were significantly different from each other (P < 0.001; Table 1). Anesthesia had a cost‐to‐charge ratio of 0.29 (plus/minus 0.03).
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Percentage of Total Cost that Are Variable Direct Costs
Table 2
Table 2
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Direct costs were 64% (plus/minus 0.1%, 95% CI plus/minus 0.2%) of operating room costs and 48% (plus/minus 0.05%, 95% CI plus/minus 0.1%) of ward costs. Variable direct costs (costs affected by a physician's clinical decision‐making) as a percentage of total departmental costs were significantly different among the hospital departments (P < 0.001; Table 2). A higher ratio (variable direct cost/total costs) within a hospital department suggests lower fixed costs and greater likelihood that decreased utilization of resources within a department will result in substantial decreases in total departmental costs. Forty‐four percent of total anesthesia costs were variable direct costs.
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Discussion

To reduce perioperative inpatient costs, hospital managers need to know the principal determinants of costs. Assuming that hospital departments with the largest proportion of costs have the highest potential for cost reduction, reduction of operating room and patient ward costs is likely to yield the largest cost gains for surgical inpatients. At our institution, relying on charge data alone may misrepresent the true magnitude of costs within a hospital department.
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Anesthesia Costs
Because charges may not accurately reflect true costs, a more precise understanding of costs is required for proper decision‐making, management of quality of care and outcomes, cost control, and negotiation of viable capitated rates. For anesthesia, physician capitation rates for hospital‐based care range from 8 to 10% whereas if the plan covers all medical care then the provider capitation rate for anesthesiologists is 3–5%.** *** We estimate that intraoperative anesthesia hospital costs constitute 5.6% of the total hospital cost of an inpatient surgical procedure. The true fraction of resources consumed due to anesthesiology practice decisions is likely greater. This is because some costs outside the operating room (e.g., preoperative laboratory testing) were not allocated to "anesthesia" but may have been due to decisions related to anesthesia care. [23].
We found that half of the intraoperative anesthesia costs are variable direct costs. The greatest cost savings occur if interventions address variable costs (e.g., intravenous supplies). [24] Choosing less costly alternatives can reduce such costs as long as the quality of care is not decreased. [25] Thus, the lower bound of costs (e.g., anesthesia drugs, intubation supplies) under immediate control of anesthesia providers is approximately 3% of inpatient surgical costs. Although the cost per case of anesthesia resources is small, given the volume of anesthetics administered, small savings per case have represented substantial savings when aggregated. [3–6].
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Hospital Cost Structure
Our results suggest that approximately one third of total operating room costs and one half of patient ward costs are indirect costs used to maintain clinical support services (e.g., Medical Records). In other words, costs associated with Medical Records, for instance, are shifted to billable clinical services such as the operating room. Varying cost‐to‐charge ratios (from 0.29 to 0.91 at our institution) for different hospital cost centers may reflect attempts to achieve reasonable profit margins and to use collections from a revenue‐producing department to support non‐revenue‐producing hospital functions. Hospital operations improvement efforts that optimize efficiencies of hospital support functions will reduce perioperative costs by reducing indirect costs. In fact, attaining the targeted level of savings from operating room restructuring, for instance, may be compromised by the large (one third) indirect component of the total cost of running an operating room.
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Costs Versus Charges
Charge data should be used cautiously in economic analyses because there is no fixed relationship between true economic costs and charges. [17–19] The reason for this may be that charges have historically relied on comparisons with competing hospitals' charges and on imprecise internal costs. Prior to implementation of Medicare's prospective payment system in 1983, the Medicare Cost Report was the main approximation of cost accounting in most hospitals. An example of where charge data might be appropriate is in outpatient care in which the patient pays "out of pocket."
The calculated overall cost‐to‐charge ratio (0.42) was consistent across operations. Therefore, relative total charges may be a reasonable proxy for relative total costs. In other words, if two patients underwent the same procedure and the first patient had twice the total charges of the second patient, then on average the first patient had twice the total costs of the second patient. However, as hospital payment methods have changed, more accurate and precise cost management requires hospital cost accounting systems to specifically measure all inputs necessary for patient care. [26] For our institution, had we only inspected patient charges as a proxy for hospital resources, we would have obtained misleading results about the proportions of costs, particularly, for the patient ward and for anesthesia.
Using cost data we found that 31% of hospital costs for radical prostatectomy was for operating room and anesthesia and 5% was for pharmacy. This is in contrast to a study of patients undergoing radical prostatectomy, which reported that 53% of the hospital charges was for the operating room and anesthesia while 16% was attributed to pharmacy. [15] Differences in local medical practice patterns may also affect the distribution of costs and charges for a particular procedure.
Differences in charge and costing methods (e.g., how resources are assigned to a hospital department) can influence the economic evaluation of a procedure. Depending on how variable and fixed costs are defined, cost differences between surgical procedures can vary significantly. [19] In this study, operating room personnel costs were considered as variable direct costs. However, if a patient does not arrive for their surgery, the personnel still must be paid. If this occurred, total costs would not change, but this labor cost could be allocated to a different cost category (e.g., variable indirect).
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Future Studies
Future studies should focus on how the practice pattern and productivity of the anesthesiologist affects other cost factors‐‐operating room efficiency, length of patient hospital stay, postoperative care requirements (e.g., intensive care unit vs. patient ward), and clinically important outcomes. For example, anesthesiologists may not be able to affect postanesthesia care unit costs to a great extent because the major determinant of postanesthesia care unit costs is the distribution of admissions. [27] The effects of changing the way perioperative care is delivered (e.g., clinical pathways) on fixed and variable hospital costs deserves further study.
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Limitations
This study was performed in a single university hospital using a well‐known cost accounting application (TSI). The results are not necessarily transferable to other institutions with other cost taxonomies. Nevertheless, the proportions of hospital departmental costs are likely to be generalizable to other hospitals. We did not evaluate ambulatory procedures, which are an important segment of surgical volume in the United States.
Anesthesia costs are a small portion of the overall costs associated with a surgical patient's hospital encounter. Our design could not evaluate the influence of physician practice patterns on "downstream" events in the hospitalization, some of which may have substantial economic impact (e.g., enhanced pain control in high‐risk patients who experience fewer postoperative adverse events). Greater cost savings may come with improving operating room efficiency as well as those processes of care that reduce length of hospital stay (while maintaining similar or improved quality of care). This would seem more important than restriction of anesthesia agents, supplies, and equipment. More studies are needed on how anesthesiologists can promote more‐cost efficient perioperative care by balancing economic pressures and the ability to deliver high quality medical care.
The authors thank Don Stanski M.D. (Department of Anesthesia, Stanford University School of Medicine) for his continuous encouragement, advice, and support of this research project.
*Rutter T, Brown A: Contemporary operating room management. Advances in Anesthesia 11:173–214, 1994.
**Personal communication, R. Miller, M.D., 3/11/95.
***Arens J: Negotiating with managed care contract holders. American Society of Anesthesiologists 1994 Annual Refresher Course Lectures. 236A:1–4, 1994.
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REFERENCES

1. Hudson R, Friesen R: Health care "reform" and the costs of anesthesia. Can J Anesth 40:1120-1125, 1993.

2. Macario A, Chang P, Stempel D, Brock-Utne J: A cost analysis of the laryngeal mask airway for adult elective outpatient anesthesia. ANETHESIOLOGY 83:250-257, 1995.

3. Becker K, Carrithers J: Practical methods of cost containment in anesthesia and surgery. J Clin Anesth 6:388-399, 1994.

4. Hawkes C, Miller D, Martineau R, Hull K, Hopkins H, Tierney M: Evaluation of cost minimization strategies of anesthetic drugs in a tertiary care hospital. Can J Anesth 41:894-901, 1994.

5. Johnstone R, Jozefczyk K: Costs of anesthetic drugs: Experiences with a cost education trial. Anesth Analg 78:766-771, 1994.

6. Szocik J, Learned D: Impact of a cost containment program on the use of volatile anesthetics and neuromuscular blocking drugs. J Clin Anesth 6:378-382, 1994.

7. Broadway P, Jones J: A method for costing anesthetic practice. Anaesthesia 50:56-63, 1995.

8. Macario A, Brock-Utne: Elimination of 12 and 24 Fr esophageal stethoscopes from anesthesia practice: An attempt at cost containment (letter). Anesth Analg 79:393, 1994.

9. Johnstone R, Martinec C: Costs of anesthesia. Anesth Analg 76:840-848, 1993.

10. Behnia R, Hashemi F, Stryker S, Ujiki G, Poticha S: A comparison of general versus local anesthesia during inguinal herniorrhaphy. Surg Gynecol Obstet 174:277-280, 1992.

11. Bredenkamp J, Abemayor E, Wackym P, Ward P: Tonsillectomy under local anesthesia: a safe and effective alternative. Am J Otolaryngol 11:18-22, 1990.

12. Riley E, Cohen S, Macario A, Desai, Ratner E: Spinal versus epidural anesthesia for Cesarean section: A comparison of time efficiency, costs, charges, and complications. Anesth Analg 80:709-712, 1995.

13. Todd M, Warner D, Sokoll M, Matkabi M, Hindman B, Scamman F, Kirschner J: A prospective, comparative trial of three anesthetics for elective supratentorial craniootomy: Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. ANETHESIOLOGY 78:1005-1020, 1993.

14. Yeager M, Glass D, Neff R, Brinck-Johnsen T: Epidural anesthesia and analgesia in high risk surgical patients. ANETHESIOLOGY 66:729-736, 1987.

15. Koch M, Smith J, Hodge W, Brandell R: Prospective development of a cost-efficient program for radical retropubic prostatectomy. Urology 44:311-318, 1994.

16. Hardy K, Miller H, McNeil, Shulkes: Measurement of surgical costs: a clinical analysis. Aust N Z J Surg. 64:607-611, 1994.

17. Orkin F: Moving toward value-based anesthesia care. J Clin Anesth 5:91-98, 1993.

18. Finkler S: The distinction between cost and charges. Ann Intern Med 96:102-109, 1992.

19. Hlatky M, Lipscomb J, Nelson C, Califf R, Pryor D, Wallace A, Mark D: Resource use and cost of initial coronary revascularization. Circulation 82(suppl IV):IV-208-IV-213, 1990.

20. Horngren C, Foster G: Cost Accounting: A Managerial Emphasis. Englewood Cliffs, Prentice-Hall, 1987, pp 39-40.

21. Kotz S, Johnson N: Encyclopedia of Statistical Sciences. Volume 3. New York, John Wiley & Sons, 1988, pp 87-88.

22. Glantz S: Primer of Biostatistics. 3rd edition. New York, McGraw Hill, 1992.

23. Macario A, Roizen M, Thisted R, Kim S, Orkin F, Phelps C: Reassessment of preoperative laboratory testing has changed the test-ordering patterns of physicians. Surg Gynecol Obstet 175:539-547.

24. Vitez T: Principles of cost analysis. J Clin Anesth 6:357-363, 1994.

25. Macario A: A health policy perspective on costs of short-term anesthesia services (letter). J Clin Anesth 7:175, 1995.

26. Chian Y: Improving hospital cost accounting with activity based costing. Health Care Manage Rev 18:71-77, 1993.

27. Dexter F, Tinker J: Analysis of strategies to decrease post-anesthesia costs. ANETHESIOLOGY 82:94-101, 1995.

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Williams, BA; DeRiso, BM; Engel, LB; Figallo, CM; Anders, JW; Sproul, KA; Ilkin, H; Harner, CD; Fu, FH; Nagarajan, NJ; Evans, JH; Watkins, WD
Journal of Clinical Anesthesia, 10(7): 561-569.

European Journal of Operational Research
Surgical case scheduling as a generalized job shop scheduling problem
Pham, DN; Klinkert, A
European Journal of Operational Research, 185(3): 1011-1025.
10.1016/j.ejor.2006.03.059
CrossRef
International Journal of Production Economics
Solving surgical cases assignment problem by a branch-and-price approach
Fei, H; Chu, C; Meskens, N; Artiba, A
International Journal of Production Economics, 112(1): 96-108.
10.1016/j.ijpe.2006.08.030
CrossRef
Surgery
The influence of clinical variables on hospital costs after orthotopic liver transplantation
Whiting, JF; Martin, J; Zavala, E; Hanto, D
Surgery, 125(2): 217-222.

Pharmacoeconomics
Clinical and economic factors important to anaesthetic choice for day-case surgery
Eger, EI; White, PF; Bogetz, MS
Pharmacoeconomics, 17(3): 245-262.

Anesthesia and Analgesia
Enterprise-wide patient scheduling information systems to coordinate surgical clinic and operating room scheduling can impair operating room efficiency
Dexter, F; Macario, A; Traub, RD
Anesthesia and Analgesia, 91(3): 617-626.

Expert Opinion on Pharmacotherapy
Cost-effectiveness of different postoperative analgesic treatments
Engoren, M
Expert Opinion on Pharmacotherapy, 4(9): 1507-1519.

Anesthesia and Analgesia
Tracheal extubation of children in the operating room after atrial septal defect repair as part of a clinical practice guideline
Laussen, PC; Reid, RW; Stene, RA; Pare, DS; Hickey, PR; Jonas, RA; Freed, MD
Anesthesia and Analgesia, 82(5): 988-993.

Anesthesia and Analgesia
An operating room scheduling strategy to maximize the use of operating room block time: Computer simulation of patient scheduling and survey of patients' preferences for surgical waiting time
Dexter, F; Macario, A; Traub, RD; Hopwood, M; Lubarsky, DA
Anesthesia and Analgesia, 89(1): 7-20.

Anesthesia and Analgesia
Part I: Propofol, thiopental, sevoflurane, and isoflurane - A randomized, controlled trial of effectiveness
Myles, PS; Hunt, JO; Fletcher, H; Smart, J; Jackson, T
Anesthesia and Analgesia, 91(5): 1163-1169.

Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Fast-tracking in ambulatory anesthesia
Song, DJ; Chung, F
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 48(7): 622-+.

Journal of Clinical Anesthesia
Laryngeal mask airway versus endotracheal tube for outpatient surgery: Analysis of anesthesia-controlled time
Hartmann, B; Banzhaf, A; Junger, A; Rohrig, R; Benson, M; Schurg, R; Hempelmann, G
Journal of Clinical Anesthesia, 16(3): 195-199.
10.1016/j.jclinane.2003.07.008
CrossRef
Paediatric Anaesthesia
The economics of newer anaesthetic drugs: Should we take the Rolls-Royce or the bicycle today?
Fazi, L; Watcha, MF
Paediatric Anaesthesia, 9(3): 181-185.

Pharmacoeconomics
Cost considerations in the use of anaesthetic drugs
Smith, I
Pharmacoeconomics, 19(5): 469-481.

British Journal of Anaesthesia
Rapacuronium: why did it fail as a replacement for succinylcholine?
White, PF
British Journal of Anaesthesia, 88(2): 163-165.

British Journal of Surgery
Low-cost laparoscopic cholecystectomy
Champault, A; Vons, C; Dagher, I; Amerlinck, S; Franco, D
British Journal of Surgery, 89(): 1602-1607.

Clinical Orthopaedics and Related Research
Economics of one-stage versus two-stage bilateral total knee arthroplasties
Macario, A; Schilling, P; Rubio, R; Goodman, S
Clinical Orthopaedics and Related Research, (): 149-156.
10.1097/01.blo.0000079265.91782.ca
CrossRef
Journal of Neurosurgery
Titanium miniplates or stainless steel wire for cranial fixation: a prospective randomized comparison
Broaddus, WC; Holloway, KL; Winters, CJ; Bullock, MR; Graham, RS; Mathern, BE; Ward, JD; Young, HF
Journal of Neurosurgery, 96(2): 244-247.

Anesthesia and Analgesia
The anesthesiologist as an ambulatory surgery facility manager
Kapur, PA; Pregler, JL
Anesthesia and Analgesia, 96(3): 48-55.

Aesthetic Plastic Surgery
Day case breast augmentation under paravertebral blockade: A prospective study of 100 consecutive patients
Cooter, RD; Rudkin, GE; Gardiner, SE
Aesthetic Plastic Surgery, 31(6): 666-673.
10.1007/s00266-006-0230-5
CrossRef
Journal of Cardiothoracic and Vascular Anesthesia
Con: General anesthesia and regional anesthesia are equally acceptable choices for carotid endarterectomy
Lineberger, CK; Lubarsky, DA
Journal of Cardiothoracic and Vascular Anesthesia, 12(1): 115-117.

Surgical Endoscopy-Ultrasound and Interventional Techniques
Cost-effective appendectomy - Open or laparoscopic? a prospective randomized study
Heikkinen, TJ; Haukipuro, K; Hulkko, A
Surgical Endoscopy-Ultrasound and Interventional Techniques, 12(): 1204-1208.

Anesthesia and Analgesia
An analysis of factors influencing postanesthesia recovery after pediatric ambulatory tonsillectomy and adenoidectomy
Edler, AA; Mariano, ER; Golianu, B; Kuan, C; Pentcheva, K
Anesthesia and Analgesia, 104(4): 784-789.
10.1213/01.ane.0000258771.53068.09
CrossRef
Orthopade
The value of regional and general anaesthesia in orthopaedic surgery
Vicent, O; Hubler, M; Kirschner, S; Koch, T
Orthopade, 36(6): 529-536.
10.1007/s00132-007-1099-y
CrossRef
European Journal of Operational Research
Scheduling elective surgery under uncertainty and downstream capacity constraints
Min, DK; Yih, Y
European Journal of Operational Research, 206(3): 642-652.
10.1016/j.ejor.2010.03.014
CrossRef
Journal of Cardiothoracic and Vascular Anesthesia
Anesthesia information-management systems: Their role in risk-versus-cost assessment and outcomes research
Gibby, GL
Journal of Cardiothoracic and Vascular Anesthesia, 11(2): 2-5.

American Journal of Health-System Pharmacy
Pharmacoeconomics of propofol in anesthesia
Tagliente, TM
American Journal of Health-System Pharmacy, 54(): 1953-1962.

American Journal of Health-System Pharmacy
Pharmacoeconomic issues related to selection of neuromuscular blocking agents
White, PF
American Journal of Health-System Pharmacy, 56(): S18-S21.

Anesthesia and Analgesia
Estimating the duration of a case when the surgeon has not recently scheduled the procedure at the surgical suite
Macario, A; Dexter, F
Anesthesia and Analgesia, 89(5): 1241-1245.

Anesthesiology
Nursing workload associated with adverse events in the postanesthesia care unit
Cohen, MM; O'Brien-Pallas, LL; Copplestone, C; Wall, R; Porter, J; Rose, DK
Anesthesiology, 91(6): 1882-1890.

European Journal of Anaesthesiology
Pharmacoeconomics in anaesthesia: what are the issues?
White, PF; Watcha, MF
European Journal of Anaesthesiology, 18(): 10-15.

Journal of Pain
The pharmacy cost of delivering postoperative analgesia to patients undergoing joint replacement surgery
Macario, A; McCoy, M
Journal of Pain, 4(1): 22-28.
10.1054/jpai.2003.2
CrossRef
Journal of Oral and Maxillofacial Surgery
Stereolithographic modeling technology applied to tumor resection
Cunningham, LL; Madsen, MJ; Peterson, G
Journal of Oral and Maxillofacial Surgery, 63(6): 873-878.
10.1016/j.joms.2005.02.027
CrossRef
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Economic aspects in anaesthesia - Part II: Costing control in clinical anaesthesia
Bach, A; Schmidt, H; Bottiger, BW; Motsch, J
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 33(4): 210-231.

Annales Francaises D Anesthesie Et De Reanimation
The industrial management and the management of surgical units
Chaabane, S; Guinet, A; Smolski, N; Guiraud, M; Luquet, B; Marcon, E; Viale, JP
Annales Francaises D Anesthesie Et De Reanimation, 22(): 904-908.
10.1016/j.annfar.2003.08.010
CrossRef
Anesthesia and Analgesia
Task analysis of the preincision surgical period: An independent observer-based study of 1558 cases
Escobar, A; Davis, EA; Ehrenwerth, J; Watrous, GA; Fisch, GS; Kain, ZN; Barash, PG
Anesthesia and Analgesia, 103(4): 922-927.
10.1213/01.ane.0000232443.24914.8d
CrossRef
Pharmacy World & Science
Cost analysis applied to postoperative analgesia regimens: a comparison between parecoxib and propacetamol
Tilleul, P; Weickmans, H; Sean, PT; Lienhart, A; Beaussier, M
Pharmacy World & Science, 29(4): 374-379.
10.1007/s11096-006-9083-x
CrossRef
Surgical Innovation
Operative Time and Other Outcomes of the Electrothermal Bipolar Vessel Sealing System (LigaSure (TM)) Versus Other Methods for Surgical Hemostasis: A Meta-Analysis
Macario, A; Dexter, F; Sypal, J; Cosgriff, N; Heniford, BT
Surgical Innovation, 15(4): 284-291.
10.1177/1553350608324933
CrossRef
Anaesthesist
The balanced scorecard. "Tool or toy" in hospitals?
Brinkmann, A; Gebhard, F; Isenmann, R; Bothner, U; Mohl, U; Schwilk, B
Anaesthesist, 52(): 947-956.
10.1007/s00101-003-0574-z
CrossRef
Journal of Clinical Anesthesia
A cost-utility and cost-effectiveness analysis of an acute pain service
Stadler, M; Schlander, M; Braeckman, M; Nguyen, T; Boogaerts, JG
Journal of Clinical Anesthesia, 16(3): 159-167.
10.1016/j.jclinane.2003.06.002
CrossRef
Anesthesia and Analgesia
The impact of choice of muscle relaxant on postoperative recovery time: A retrospective study
Ballantyne, JC; Chang, YC
Anesthesia and Analgesia, 85(3): 476-482.

Regional Anesthesia and Pain Medicine
Postoperative epidural injection of saline can shorten postanesthesia care unit time for knee arthroscopy patients
Brock-Utne, JG; Macario, A; Dillingham, MF; Fanton, GS
Regional Anesthesia and Pain Medicine, 23(3): 247-251.

Anesthesia and Analgesia
The pharmacoeconomics of neuromuscular blocking drugs
Chiu, JW; White, PF
Anesthesia and Analgesia, 90(5): S19-S23.

Anesthesia and Analgesia
A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery
Beers, RA; Calimlim, JR; Uddoh, E; Esposito, BF; Camporesi, EM
Anesthesia and Analgesia, 91(6): 1420-1425.

Knee
Simultaneous Bilateral Total Knee Replacement: A persistent controversy
Noble, J; Goodall, JR; Noble, DJ
Knee, 16(6): 420-426.
10.1016/j.knee.2009.04.009
CrossRef
Anesthesia and Analgesia
The effect of a drug and supply cost feedback system on the use of intraoperative resources by anesthesiologists
Berman, MF; Simon, AE
Anesthesia and Analgesia, 86(3): 510-515.

Anesthesiology
Forecasting surgical groups' total hours of elective cases for allocation of block time - Application of time series analysis to operating room management
Dexter, F; Macario, A; Qian, F; Traub, RD
Anesthesiology, 91(5): 1501-1508.

Anesthesia and Analgesia
Scheduling surgical cases into overflow block time - Computer simulation of the effects of scheduling strategies on operating room labor costs
Dexter, F; Macario, A; O'Neill, L
Anesthesia and Analgesia, 90(4): 980-988.

Anesthesia and Analgesia
Hospital profitability per hour of operating room time can vary among surgeons
Macario, A; Dexter, F; Traub, RD
Anesthesia and Analgesia, 93(3): 669-675.

Computers & Operations Research
An elective surgery scheduling problem considering patient priority
Min, DK; Yih, Y
Computers & Operations Research, 37(6): 1091-1099.
10.1016/j.cor.2009.09.016
CrossRef
Anesthesia and Analgesia
Economic benefits attributed to opening a preoperative evaluation clinic for outpatients
Pollard, JB; Zboray, AL; Mazze, RI
Anesthesia and Analgesia, 83(2): 407-410.

Regional Anesthesia
Cost-effectiveness and cost/benefit ratio of acute pain management
Rauck, RL
Regional Anesthesia, 21(6): 139-143.

Anesthesiology
Nonpatient care obligations of anesthesiologists
Waisel, DB
Anesthesiology, 91(4): 1152-1158.

American Journal of Surgery
Efficiency of the operating room suite
Weinbroum, AA; Ekstein, O; Ezri, T
American Journal of Surgery, 185(3): 244-250.
10.1016/S0002-9610(02)01362-4
CrossRef
Anasthesiologie & Intensivmedizin
Cost accounting and performance controlling: Implications from the use of DRGS in a performance-oriented financing model - The Swiss experience
Schupfer, G; Patzen, M; Schleppers, A
Anasthesiologie & Intensivmedizin, 45(): 730-732.

Anesthesia and Analgesia
Tactical increases in operating room block time for capacity planning should not be based on utilization
Wachtel, RE; Dexter, F
Anesthesia and Analgesia, 106(1): 215-226.
10.1213/01.ane.0000289641.92927.b9
CrossRef
Surgical Endoscopy-Ultrasound and Interventional Techniques
Laparoscopic colposuspension - Is it cost-effective?
Loveridge, K; Malouf, A; Kennedy, C; Edgington, A; Lam, A
Surgical Endoscopy-Ultrasound and Interventional Techniques, 11(7): 762-765.

Anesthesia and Analgesia
The problem with long-acting muscle relaxants? They cost more!
Caldwell, JE
Anesthesia and Analgesia, 85(3): 473-475.

Cns Drug Reviews
Sevoflurane: Approaching the ideal inhalational anesthetic a pharmacologic, pharmacoeconomic, and clinical review
Delgado-Herrera, L; Ostroff, RD; Rogers, SA
Cns Drug Reviews, 7(1): 48-120.

Chest
Is a charge a cost if nobody pays it?
Engoren, M
Chest, 126(3): 662-664.

Anaesthesia and Intensive Care
Effect of newer anaesthetics on duration of stay in postanaesthesia care unit in patients undergoing major abdominal surgery
Gonano, C; Sitzwohl, C; Leitgeb, U; Landsteiner, HT; Zimpfer, M; Kettner, SC
Anaesthesia and Intensive Care, 33(3): 356-360.

Pharmacotherapy
Inhalation anesthesiology and volatile liquid anesthetics: Focus on isoflurane, desflurane, and sevoflurane
Sakai, EM; Connolly, LA; Klauck, JA
Pharmacotherapy, 25(): 1773-1788.

American Journal of Cardiology
Influence of cardiac risk factors and medication on length of hospitalization in patients undergoing major vascular surgery
Van de Pol, MA; van Houdenhoven, M; Hans, EW; Boersma, E; Bax, JJ; Feringa, HHH; Schouten, O; van Sambeek, MRHM; Poldermans, D
American Journal of Cardiology, 97(): 1423-1426.
10.1016/j.amjcard.2005.12.032
CrossRef
Anesthesia and Analgesia
Use of outpatient preoperative evaluation to decrease length of stay for vascular surgery
Pollard, JB; Garnerin, P; Dalman, RL
Anesthesia and Analgesia, 85(6): 1307-1311.

Anesthesia and Analgesia
The effect of a perioperative clinical pathway for knee replacement surgery on hospital costs
Macario, A; Horne, M; Goodman, S; Vitez, T; Dexter, F; Heinen, R; Brown, B
Anesthesia and Analgesia, 86(5): 978-984.

Anesthesia and Analgesia
The changing role of monitored anesthesia care in the ambulatory setting
SaRego, MM; Watcha, MF; White, PF
Anesthesia and Analgesia, 85(5): 1020-1036.

Anaesthesist
Operating room management
Alon, E; Schupfer, G
Anaesthesist, 48(): 689-697.

Annales Francaises D Anesthesie Et De Reanimation
Auditing the choice of anaesthetic agents
Benhamou, D; Laurent, S; Mercier, FJ; Preaux, N
Annales Francaises D Anesthesie Et De Reanimation, 19(2): 86-92.

Anesthesia and Analgesia
The anesthesiologist as an ambulatory surgery facility manager
Kapur, PA; Pregler, JL
Anesthesia and Analgesia, 94(3): 62-69.

Journal of Clinical Anesthesia
Comparison of hemodynamics, recovery profile, and early postoperative pain control and costs of remifentanil versus alfentanil-based total intravenous anesthesia (TIVA)
Ozkose, Z; Cok, OY; Tuncer, B; Tufekcioglu, S; Yardim, S
Journal of Clinical Anesthesia, 14(3): 161-168.
PII S0952-8180(01)00368-3
CrossRef
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
The hidden cost of anesthesia
Bevan, D
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 49(6): 533-535.

Energy and Buildings
HVAC and indoor thermal conditions in hospital operating rooms
Balaras, CA; Dascalaki, E; Gaglia, A
Energy and Buildings, 39(4): 454-470.
10.1016/j.enbuild.2006.09.004
CrossRef
Anaesthesia
The limitations of using operating room utilisation to allocate surgeons more or less surgical block time in the USA
Macario, A
Anaesthesia, 65(6): 548-552.
10.1111/j.1365-2044.2010.06374.x
CrossRef
Anesthesia and Analgesia
The costs of intense neuromuscular block for anesthesia during endolaryngeal procedures due to waiting time
Puura, AIE; Rorarius, MGF; Manninen, P; Hopput, S; Baer, GA
Anesthesia and Analgesia, 88(6): 1335-1339.

Anesthesia and Analgesia
Part II: Total episode costs in a randomized, controlled trial of the effectiveness of four anesthetics
Jackson, T; Myles, PS
Anesthesia and Analgesia, 91(5): 1170-1175.

Clinical Therapeutics
Low Fresh Gas Flow Balanced Anesthesia Versus Target Controlled Intravenous Infusion Anesthesia in Laparoscopic Cholecystectomy: A Cost-Minimization Analysis
Stevanovic, PD; Petrova, G; Miljkovic, B; Scepanovic, R; Perunovic, R; Stojanovic, D; Dobrasinovic, J
Clinical Therapeutics, 30(9): 1714-1725.
10.1016/j.clinthera.2008.09.009
CrossRef
Journal of Clinical Anesthesia
What does one minute of operating room time cost?
Macario, A
Journal of Clinical Anesthesia, 22(4): 233-236.
10.1016/j.jclinane.2010.02.003
CrossRef
Pharmacoeconomics
Economic considerations related to providing adequate pain relief for women in labour - Comparison of epidural and intravenous analgesia
Huang, C; Macario, A
Pharmacoeconomics, 20(5): 305-318.

Anaesthesist
Accessible price lists at the anaesthesiologist's workplace enhance cost consciousness as a part of process and cost optimization
Snyder-Ramos, SA; Bauer, M; Martin, E; Motsch, J; Bottiger, BW
Anaesthesist, 52(2): 154-161.
10.1007/s00101-002-0413-7
CrossRef
Anasthesiologie & Intensivmedizin
Statutes for the central management of an operating theatre - boon or bane for the process flow?
Schleppers, A; Sturm, J; Bender, HJ
Anasthesiologie & Intensivmedizin, 44(4): 295-303.

Iie Transactions
A sequential bounding approach for optimal appointment scheduling
Denton, B; Gupta, D
Iie Transactions, 35(): 1003-1016.
10.1080/07408170390230169
CrossRef
Anasthesiologie & Intensivmedizin
Effectiveness, weak points analysis and potentials for improving the operating room management in hospitals
Denz, C; Zoller, A; Baumgart, A; Paulussen, T; Schleppers, A; Badreddin, E; Heinzl, A; Bender, HJ
Anasthesiologie & Intensivmedizin, 48(): 580-+.

Anesthesia and Analgesia
Spinal versus general anesthesia for orthopedic surgery: Anesthesia drug and supply costs
Gonano, C; Leitgeb, U; Sitzwohl, C; Ihra, G; Weinstabl, C; Kettner, SC
Anesthesia and Analgesia, 102(2): 524-529.
10.1213/01.ane.0000194292.81614.c6
CrossRef
Urologia Internationalis
Introducing The Productive Operating Theatre Programme in Urology Theatre Suites
Ahmed, K; Khan, N; Anderson, D; Watkiss, J; Challacombe, B; Khan, MS; Dasgupta, P; Cahill, D
Urologia Internationalis, 90(4): 417-421.

Anesthesiology
Economics of Nerve Block Pain Management after Anterior Cruciate Ligament Reconstruction: Potential Hospital Cost Savings via Associated Postanesthesia Care Unit Bypass and Same-day Discharge
Williams, BA; Kentor, ML; Vogt, MT; Vogt, WB; Coley, KC; Williams, JP; Roberts, MS; Chelly, JE; Harner, CD; Fu, FH
Anesthesiology, 100(3): 697-706.

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Anesthesiology
Economics of Anesthetic Practice
Watcha, MF; White, PF
Anesthesiology, 86(5): 1170-1196.

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Anesthesiology
Meaningful Cost Reduction: Penny Wise, Pound Foolish
Orkin, FK
Anesthesiology, 83(6): 1135-1137.

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Anesthesiology
Obstetric Postanesthesia Care Unit Stays: Reevaluation of Discharge Criteria after Regional Anesthesia
Cohen, SE; Hamilton, CL; Riley, ET; Walker, DS; Macario, A; Halpern, JW
Anesthesiology, 89(6): 1559-1565.

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Anesthesiology
Effect of Different Cost Drivers on Cost per Anesthesia Minute in Different Anesthesia Subspecialties
Schuster, M; Standl, T; Wagner, JA; Berger, J; Reimann, H; am Esch, JS
Anesthesiology, 101(6): 1435-1443.

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Clinical Obstetrics and Gynecology
Cost-Effectiveness of a Trial of Labor After Previous Cesarean Delivery Depends on the A Priori Chance of Success
MACARIO, A; EL-SAYED, YY; DRUZIN, ML
Clinical Obstetrics and Gynecology, 47(2): 378-385.

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European Journal of Anaesthesiology (EJA)
Shorter discharge time after regional or intravenous anaesthesia in combination with laryngeal mask airway compared with balanced anaesthesia with endotracheal intubation
Junger, A; Klasen, J; Hartmann, B; Benson, M; Röhrig, R; Kuhn, D; Hempelmann, G
European Journal of Anaesthesiology (EJA), 19(2): 119-124.

Journal of Neurosurgical Anesthesiology
Inhalation Versus Total Intravenous Anesthesia for Lumbar Disc Herniation: Comparison of Hemodynamic Effects, Recovery Characteristics, and Cost
Ozkose, Z; Ercan, B; Ünal, Y; Yardim, S; Kaymaz, M; Dogulu, F; Pasaoglu, A
Journal of Neurosurgical Anesthesiology, 13(4): 296-302.

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Anesthesiology
Use of Linear Programming to Estimate Impact of Changes in a Hospital's Operating Room Time Allocation on Perioperative Variable Costs
Dexter, F; Blake, JT; Penning, DH; Sloan, B; Chung, P; Lubarsky, DA
Anesthesiology, 96(3): 718-724.

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Anesthesiology
Individualized Feedback of Volatile Agent Use Reduces Fresh Gas Flow Rate, but Fails to Favorably Affect Agent Choice
Body, SC; Fanikos, J; DePeiro, D; Philip, JH; Segal, SB
Anesthesiology, 90(4): 1171-1175.

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Anesthesiology
The Successful Implementation of Pharmaceutical Practice Guidelines: Analysis of Associated Outcomes and Cost Savings
Lubarsky, DA; Glass, PS; Ginsberg, B; de Dear, GL; Dentz, ME; Gan, TJ; Sanderson, IC; Mythen, MG; Dufore, S; Pressley, CC; Gilbert, WC; White, WD; Alexander, ML; Coleman, RL; Rogers, M; Reves, J
Anesthesiology, 86(5): 1145-1160.

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Anesthesiology
Statistical Method to Evaluate Management Strategies to Decrease Variability in Operating Room Utilization: Application of Linear Statistical Modeling and Monte Carlo Simulation to Operating Room Management
Dexter, F; Macario, A; Lubarsky, DA; Burns, DD
Anesthesiology, 91(1): 262-274.

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Critical Care Medicine
Early indicators of prolonged intensive care unit stay: Impact of illness severity, physician staffing, and pre–intensive care unit length of stay
Higgins, TL; McGee, WT; Steingrub, JS; Rapoport, J; Lemeshow, S; Teres, D
Critical Care Medicine, 31(1): 45-51.

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Critical Care Medicine
The effect of prompt physician visits on intensive care unit mortality and cost
Engoren, M
Critical Care Medicine, 33(4): 727-732.
10.1097/01.CCM.0000157787.24595.5B
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European Journal of Anaesthesiology (EJA)
Cost implications of the practice of anaesthesiology
POURRIAT, J
European Journal of Anaesthesiology (EJA), 15(1): 124.

European Journal of Anaesthesiology (EJA)
Comparative analysis of costs of total intravenous anaesthesia with propofol and remifentanil vs. balanced anaesthesia with isoflurane and fentanyl
Epple, J; Kubitz, J; Schmidt, H; Motsch, J; Böttiger, B; Martin, E; Bach, A
European Journal of Anaesthesiology (EJA), 18(1): 20-28.

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European Journal of Anaesthesiology (EJA)
Anaesthesiology directors: more support on the way as Association of Anesthesia Clinical Directors goes international
Thoms, G
European Journal of Anaesthesiology (EJA), 17(2): 77-78.

Obstetrics & Gynecology
Cost‐Effectiveness of a Trial of Labor After Previous Cesarean
CHUNG, A; MACARIO, A; EL-SAYED, YY; RILEY, ET; DUNCAN, B; DRUZIN, ML
Obstetrics & Gynecology, 97(6): 932-941.

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Plastic and Reconstructive Surgery
Financial Impact of Hand Surgery Programs on Academic Medical Centers
Hasan, JS; Chung, KC; Storey, AF; Bolg, ML; Taheri, PA
Plastic and Reconstructive Surgery, 119(2): 627-635.
10.1097/01.prs.0000246528.28652.11
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Back to Top | Article Outline
Keywords:
Anesthesia costs; Economics; Hospital costs; Patient charges; Surgery costs

© 1995 American Society of Anesthesiologists, Inc.

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