Abstract
Purpose
The increased experience of a thyroid surgeon reduces the risk of postoperative complications. However, whether it is also cost-effective is currently unknown. The aim of the present study was to compare cost-effectiveness of high-volume (HVS) with low-volume surgeons (LVS) when performing a total thyroidectomy.
Methods
This was a retrospective study, comparing the mean cost of a total thyroidectomy per patient, between HVS and LVS. This included the cost of surgical procedure and pre- and post-operative inpatient hospitalization. A threshold of 25 thyroidectomies/year was used to discriminate between HVS and LVS.
Results
Four-hundred and forty-one patients were classified into HVS and 342 into the LVS group. With regard to surgical complications, higher rates of temporary hypoparathyroidism and endangered airway were observed in the LVS than in the HVS group. The estimated total cost per patient was higher in the LVS compared with the HVS group [€1721 ± 396 ($1910 ± 439) versus €979 ± 68 ($1086 ± 487); p < 0.0001]. This cost remained higher when sub-analysis was performed for each surgical stage, involving either surgical procedure or pre- and post-operative inpatient hospitalization. Differences between LVS and HVS mainly involved the cost in surgical procedure (23% attributed to occupation of the operating room) and postoperative inpatient hospitalization (45% of the total thyroidectomy cost).
Conclusion
Total thyroidectomy performed by a HVS seems to be cost-effective compared with the one conducted by LVS. This is mostly attributed to the lower rates of surgical complications, such as postoperative hypoparathyroidism and airway obstruction.
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Author contribution
PA analyzed the data and wrote the first draft of the paper. IP and SP provided surgical data and searched the literature. AC was responsible for the statistical analysis and reviewed the manuscript. VS and AM reviewed the manuscript and provided critical scientific input. TSP conceived the idea of the study, provided critical scientific input and had the primary responsibility for the paper’s final content.
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Anagnostis, P., Pliakos, I., Panidis, S. et al. Should total thyroidectomies be performed by high-volume endocrine surgeons? A cost-effectiveness analysis. Endocrine 67, 131–135 (2020). https://doi.org/10.1007/s12020-019-02087-5
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DOI: https://doi.org/10.1007/s12020-019-02087-5