Surgeon-Level Value Measurement in Colectomy: Independent Domains of Cost, Efficiency, Conversion, and Outcomes
Ramsey M. Dallal, Valerie Bauer, David Berg, Jason Lei, Amanda Stella-Adams, Thaer ObaidBACKGROUND:
Quality metrics and research on colectomy outcomes, such as operative costs, efficiency, conversion avoidance, and postoperative complications, are often examined separately and may lose sight of the complex, holistic nature of care.
OBJECTIVE:
To examine what enterprise colectomy dashboards can, and cannot, tell surgeons about value.
DESIGN:
Retrospective cohort study using enterprise administrative and operative data.
SETTINGS:
Multihospital academic health system.
PATIENTS:
Adult index colectomy cases from 2017 through early 2026.
MAIN OUTCOME MEASURES:
Surgeon case volume, measure availability, room time, disposable supply cost, length of stay, conversion, reoperation, reintervention, and readmission.
RESULTS:
The cohort included 5,831 colectomies by 194 surgeons; median surgeon volume was 9.5 cases, and 97 had fewer than 10 cases. Measure capture varied: room time, reoperation, and reintervention were complete; length of stay was analyzable for 3,360 cases (57.6%), and readmission for 1,745 (29.9%). Room time and disposable supply cost showed surgeon-level variation; length of stay showed little surgeon-level variation after adjustment. Surgeon cost and room-time effects were weakly correlated (r = 0.10), and cost and length of stay effects were not correlated (r = −0.04). Higher disposable cost was not associated with fewer reoperations or reinterventions. Robotic platform use was associated with lower conversion (2.3 vs 7.7%); the $35,648 added disposable cost per avoided conversion is a transparent tradeoff calculation, not a cost-effectiveness estimate.
LIMITATIONS:
Diagnosis, disease severity, and comorbidity data were unavailable; length of stay and readmission were incompletely captured; cost reflects disposable supplies only.
CONCLUSIONS:
Analyses of the value of colectomy should not rely on a single endpoint. Cost, efficiency, conversion, recovery, readmission, reintervention, and complications should be evaluated together, with denominators and reliability visible in research, rankings, compensation, or platform judgements. See Video Abstract.