title: How to optimize the economic viability of thyroid surgery in a French public hospital?
abstract: OBJECTIVE
  Physicians in France have been asked to change their day-to-day medical practice to reduce overall costs. We examine ways to achieve this goal in thyroid surgery.
  
  
  METHODS
  We defined and implemented a clinical pathway to optimize the economic viability of thyroid surgery by increasing revenues and lowering expenses. An increase in revenue was achieved by decreasing patient length of stay (LOS) through the use of a fast-track rehabilitation protocol. Expenses were decreased by performing all pre-operative work-up in the out-patient setting and by decreasing costs in the operating room.
  
  
  RESULTS
  For 292 consecutive patients who underwent thyroidectomy, the average LOS has been decreased over time to a mean of 2.03 days in 2008; 96% of patients were discharged on the first postoperative day. These results were primarily achieved by using a fast-track rehabilitation clinical pathway, and no increase in postoperative morbidity was noted. Operating time was decreased by 20% through the use of a second surgical assistant and hemostatic scissors but this improvement did not translate into better daily utilization of the operating room.
  
  
  CONCLUSIONS
  The economic profitability of thyroid surgery is improved when mean LOS is reduced to 2 days through a fast-track protocol. Decreasing the duration of hospitalization was more effective than decreasing operative duration in controlling overall costs.
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Sud-Francilien, Quartier du Canal, Courcouronnes, 91014 Evry, France. etienne.dhubert@ch-sud-francilien.fr
authors.forename: E
authors.initials: E
authors.lastname: D'Hubert
authors.forename: J-M
authors.initials: JM
authors.lastname: Proske
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D017046:Cost Savings / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000191:economics*; D005602:France; D017721:Hospital Costs / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D009313:National Health Programs / Q000191:economics*; D009873:Operating Rooms / Q000191:economics / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000191:economics; D011445:Prospective Payment System / Q000191:economics; D013964:Thyroid Neoplasms / Q000191:economics* / Q000601:surgery*; D016606:Thyroid Nodule / Q000191:economics* / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics*; D013996:Time and Motion Studies