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Comparison of Costs and Outcomes for In-Office and Operating Room Excision of Nonmelanoma Skin Cancer

Ovadia, Steven A. MD*†; Spector, Seth A. MD, FACS†‡; Thaller, Seth R. MD, DMD, FACS*†

doi: 10.1097/SAP.0000000000001744
Reconstructive Surgery
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Introduction With increasing health care expenses and limited resources, it is important to evaluate potential means of reducing cost while maintaining efficacy and safety. The purpose of our study was to compare the cost and outcomes of surgical excision of nonmelanoma skin cancer (NMSC) in the operating room versus an outpatient procedure clinic.

Methods A retrospective review of patients undergoing excision of biopsy-confirmed NMSC at the Miami Veterans Affairs Hospital between December 1, 2015, and December 1, 2016, was completed. Patients treated in the operating room and procedure clinic were included. Treatment outcomes were assessed for all identified patients. Patients undergoing excision and primary closure were included for cost comparison.

Procedure costs were estimated using Current Procedural Terminology codes for treatments provided and the 2017 conversion factor of $35.7751. If a second operation for positive margins was necessary, cost to treat the lesion included costs from both procedures. If multiple lesions were treated, total cost was divided by the number of lesions to calculate cost per lesion treated. Costs per lesion managed in the operating room and clinic were compared using the Student t test.

Results Sixty-five patients underwent excision of 94 NMSCs in the operating room. Nineteen patients underwent excision of 20 NMSCs in the procedure clinic. One patient treated in the clinic required re-excision in the operating room with frozen section for a positive margin.

Thirty-three patients managed in the operating room and 19 patients managed in the procedure clinic were included for cost analysis. Average costs per lesion excised in the operating room and procedure clinic were calculated to be $1923.43 ± 616.27 and $674.88 ± 575.22, respectively (P < 0.001).

Conclusions Excellent oncologic outcomes were achieved for both operating room and procedure clinic excision. Excision in the operating room excision was significantly more expensive than in the procedure clinic. Excision in a procedure clinic offers an opportunity to reduce costs while maintaining quality care.

From the *DeWitt-Daughtry Family Department of Surgery and

Division of Plastic, Aesthetic and Reconstructive Surgery, University of Miami, Leonard Miller School of Medicine; and

Department of Surgery, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL.

Received July 16, 2018, and accepted for publication, after revision October 6, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Seth R. Thaller, MD, DMD, FACS, Division of Plastic, Aesthetic and Reconstructive Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami, Leonard Miller School of Medicine, Clinical Research Building, 1120 NW 14th St, 4th Floor, Miami, FL 33136. E-mail: SThaller@med.miami.edu.

Online date: January 10, 2019

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