Abstract

YASMANY CABRERA, Elkin; CIFUENTES, Paola Andrea; SANABRIA, Álvaro  and  DOMINGUEZ, Luis Carlos. Ambulatory thyroidectyomy: cost-minimization analysis in Colombia. rev. colomb. cir. [online]. 2014, vol.29, n.4, pp.319-326. ISSN 2011-7582.

Background. Current data suggests that thyroidectomy is the most common neck surgical procedure. Thyroidectomy has traditionally performed in a hospital environment; however it has been suggested that ambulatory thyroidectomy is equally safe and could be more cost-effective. The aim of this study was to estimate the cost and safety of the outpatient thyroidectomy compared to the inpatient procedure in low risk patients. Methods. This is a study of cohorts of mixed temporality and design of cost-minimization analysis. The sampling was a cohort of patients undergoing thyroidectomy between July 2013 and January 2014 at the Surgery Department of Pablo Tobón Uribe Hospital, Medellín, Colombia. Direct costs of intervention in the outpatients and inpatients was the main measuring factor. A cost-minimization analysis was developed by the microcosting method, extrapolating prices as follows: for medicines, the 2013 pharma products guide; for surgical supplies from the Colombian public purchasing reports posted in the internet; and for paraclinical tests, type of surgery, and human resources the 2014 SOAT (Colombian mandatory auto accident insurance) report. The statistical variables were age, gender, type and indication of surgery, operating time, length of hospital stay, complications, and costs. Groups were compared and the effect of the inpatient management impact was isolated, adjusting it with a multiple regression model. Results. 44 patients were included in the study, 52.3 % (n = 23) were managed as outpatients and 47.7 % (n = 21) as inpatients. There were no statistically significant differences in age, type of thyroidectomy, indication for surgery, ASA (American Society of Anesthesiologists) classification and operating time. The overall rate of complications was not different between the two groups (p = 0.82). The overall cost difference was $ 378,531 COP (COP 2'657.810 in the outpatient group vs. COP 3'036.341 in the inpatient group) (p < 0.01). When adjusting the use of resources for variables, implementation of ambulatory thyroidectomy protocols may reduce the procedure cost by 12.5 %. Conclusion. Outpatient thyroidectomy is a viable procedure, and in selected patients it allows minimization of costs a safe way.

Keywords : Thyroid gland; thyroidectomy; ambulatory surgical procedures; costs and cost analysis; postoperative Complications.

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