title: [Morbidity and costs in complete thyroidectomies. Improvement in Value of the Process by a change in the management].
abstract: OBJECTIVE
  1) To present the postoperative morbidity of complete thyroidectomies and the results of their clinical management and costs obtained after surgery. 2) To compare the results obtained for the morbidity and costs in the complete thyroidectomy Process, after the management changes introduced by the Endocrine Surgical Unit (ESU). 3) To define whether these changes improve the Value (benefit/cost ratio) of the Process.
  
  
  METHODS
  Prospective study of cohorts conducted on 529 complete thyroidectomies performed between 1998 and 2011. We present their clinical-pathological characteristics and we compare the clinical and management results obtained after surgery in 2 time periods: 1998-2006 without ESU (group 1, 205 patients) and 2007-2011 with ESU (group 2, 324 patients). The clinical results and the possible benefits are assessed by studying the morbimortality (recurrent lesions, hypocalcaemia [<8 mg/dl], suffocative haematomas and bleeding), and those of management, for the evaluation of the use of operating room time, the average stay and the total cost of the Process. The statistical comparison study was made using Student t test, for the comparison of means and the Chi(2) to compare percentages, accepting P<.05 as significant.
  
  
  RESULTS
  The global percentage of transient recurrent dysfunctions (TRD) was 6%, and for definitive recurrent paralysis (DRP) it was 1.5%. Hypocalcaemia, at 24 hours was 54.6%, at one month 7%, at six months 6.2% and that of definitive hypoparathyroidism 1.3%. There were 2.8% of suffocative haematomas and 2% adverse effects. The mean surgical time was 98 minutes, and the average stay was 3.66 days. In the comparison of results of the groups, the ESU improved the TRD index by nearly 7 points (10.2 vs. 3.4%, P=.002), that of DRP by 1.5 (2.4 vs. 0.4%; P=.3) until reaching under 1%. The figures on bleeding at 24 hours (53 vs. 44 cc; P=.002) and 48 hours (23 to 17 cc; P<.001), the rate of haematomas by another 6 points (6.3 vs. 0.6%; P<.001), and that of hypocalcaemia at 24 hours (P=.01). The average stay also improved (4.79 vs. 2.94 days; P<.001), the use of operating room time (reduced by 20 minutes/operation; P<.001), the total cost of the Process, decreasing by more than € 2,000/Process (P<.001), and produced a total savings for the hospital in the period of study of € 665,820.
  
  
  CONCLUSIONS
  1) The global results (post-operative morbidity) of our total thyroidectomies are within the quality standards. 2) The surgical specialisation and the changes introduced by the ESU improved the clinical results (greater benefit) and those of management, cutting down the average stay and the operating room usage time and decreasing costs. 3) The change in management increased the Value of the Process.
authors.affiliation: Unidad de Cirugía Endocrina, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Basurto, Bilbao, España. angel.gomezpalacios@osakidetza.net
authors.forename: A
authors.initials: A
authors.lastname: Gómez Palacios
authors.forename: B
authors.initials: B
authors.lastname: Barrios
authors.forename: M T
authors.initials: MT
authors.lastname: Gutiérrez
authors.forename: A
authors.initials: A
authors.lastname: Expósito
authors.forename: J
authors.initials: J
authors.lastname: Gómez Zabala
authors.forename: B
authors.initials: B
authors.lastname: Roca
authors.forename: P
authors.initials: P
authors.lastname: Pérez de Villarreal
authors.forename: S
authors.initials: S
authors.lastname: Ruiz
authors.forename: A
authors.initials: A
authors.lastname: Escobar
authors.forename: I
authors.initials: I
authors.lastname: Iturburu
authors.forename: J
authors.initials: J
authors.lastname: Méndez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D013965:Thyroidectomy / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D055815:Young Adult