29 A Demonstration of Opportunity Cost in Surgical Delays When Using Needle Localization Versus MOLLI Localization in Breast Surgery

Background

Opportunity cost represents the potential benefit lost when selecting one technology over another. In breast surgery, this is exemplified by comparing wire-guided needle localization with wireless magnetic occult lesion localization instrument (MOLLI) localization. Operating room (OR) delays increase hospital costs and reduce productivity, often stemming from scheduling and coordination inefficiencies. Needle localization requires same-day radiologic placement, which may disrupt OR workflows, whereas wire-free systems such as MOLLI allow flexible preoperative placement. The MOLLI Marker is a nonradioactive, wire-free device that can remain in situ for over 30 days. This study compares the impact of needle vs MOLLI localization on OR start times and delays, emphasizing the opportunity costs associated with each approach.

Materials and Methods

We performed a retrospective review of patients undergoing breast localization with either MOLLI or wire-guided needle localization between September 1, 2023, and June 1, 2025, at 2 institutions. Operative metrics were compared to assess workflow efficiency. Continuous variables (delay duration and surgical time, minutes) were summarized as mean ± SD and compared using 2-sided independent t tests, with differences in means reported with 95% CIs. Categorical variables, including the presence of OR delay (defined as case start after scheduled time), were summarized as frequencies and compared using chi-squared tests, reported as absolute percentage differences with 95% CIs. Statistical significance was defined as P <.05. Analyses were performed using R version 4.3.2. Opportunity cost was defined as forgone physician and hospital revenue due to reduced surgical throughput.

Results

Median delay was significantly shorter for MOLLI cases (n = 143) than for wire-guided cases (n = 161): 11 minutes (IQR, 0-43) vs 30 minutes (IQR, 6-54; P = .00084). Surgical times were similar between groups (121.9 vs 119.2 minutes; P = .767). MOLLI cases experienced fewer delays overall (60.1% vs 86.8%; P <.001), representing a 27% relative reduction. Assuming a scheduled OR duration of 1.5 hours, estimated total OR times, including delays, were 1.61 hours for MOLLI and 1.93 hours for wire-guided cases. Accounting for radiology-related start delays and intraoperative inefficiency, wire-guided localization resulted in approximately 1.8 hours of lost OR time per day. This allows for at least 1 additional case per operative day using MOLLI, corresponding to approximately 150 additional cases annually. Assuming a partial mastectomy (CPT 19301), this increased efficiency translates to an estimated annual revenue gain of $97,088 for physicians and $575,892 for hospitals, for a combined opportunity cost of $672,980 per year.

Conclusion

MOLLI localization is associated with earlier OR start times and fewer delays compared with needle localization. Adoption of MOLLI may substantially improve both operational efficiency and financial performance.