title: Cost analysis of intraoperative frozen section examinations in thyroid surgery in a Canadian tertiary center.
abstract: OBJECTIVE
  To perform a cost analysis of the routine intraoperative frozen section (FS) examinations in the management of patients undergoing thyroid surgery for unilateral thyroid nodules with benign or indeterminate cytology on preoperative fine-needle aspiration biopsies (FNABs).
  
  
  METHODS
  A retrospective chart review of 190 consecutive patients with unilateral thyroid nodules undergoing thyroid surgery was undertaken between March 2006 and March 2008. The results of FNAB, FS, and final histology were obtained from the pathology report. A cost analysis was performed to compare the cost of routine FS examinations to determine malignancy with the cost of performing a second surgical procedure.
  
  
  RESULTS
  Of the 169 patients evaluated, there were 53 cases of malignant nodules. Malignancy was diagnosed by FS in 16 of these 53 cases, resulting in a total thyroidectomy and thereby avoiding the need for a completion thyroidectomy. The sensitivity and specificity of FS examination were 30.2% and 100.0%, respectively. The routine use of intraoperative FS examination in cases of benign or indeterminate nodules afforded a total cost savings of $3719.27, or a cost savings of $22.01 per patient.
  
  
  CONCLUSIONS
  FS examination was useful in guiding our intraoperative management for patients with unilateral thyroid nodules with benign or indeterminate preoperative FNAB. The routine use of FS was cost-effective in our Canadian health care system, even without considering the intangible costs, such as patients' anxiety, emotional stress, and the loss of productivity owing to a second surgical procedure.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada. philip.lai@utoronto.ca
authors.forename: Philip
authors.initials: P
authors.lastname: Lai
authors.forename: Lorne
authors.initials: L
authors.lastname: Segall
authors.forename: Nevin
authors.initials: N
authors.lastname: de Korompay
authors.forename: Ian
authors.initials: I
authors.lastname: Witterick
authors.forename: Jeremy
authors.initials: J
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002170:Canada; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005629:Frozen Sections / Q000191:economics*; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult