title: Effects of a cost-effective surgical workflow on cosmesis and patient's satisfaction in open thyroid surgery.
abstract: OBJECTIVE
  In thyroid surgery, minimally invasive procedures are thought to improve cosmesis and patient's satisfaction. However, studies using standardized tools are scarce, and results are controversial. Moreover, minimally invasive techniques raise the question of material costs in a context of health spending cuts. The aim of the present study is to test a cost-effective surgical workflow to improve cosmesis in conventional open thyroid surgery.
  
  
  METHODS
  Our study ran between January 2009 and November 2010, and was based on a prospectively maintained thyroid surgery register. Patients operated for benign thyroid diseases were included. Since January 2010, a standardized surgical workflow was used in addition to the reference open procedure to improve the outcome. Two groups were created: (1) G1 group (patients operated with the reference technique), (2) G2 group (patients operated with our workflow in addition to reference technique). Patients were investigated for postoperative outcomes, self-evaluated body image, cosmetic and self-confidence scores.
  
  
  RESULTS
  820 patients were included in the present study. The overall body image and cosmetic scores were significantly better in the G2 group (P < 0.05). No significant difference was noted in terms of surgical outcomes, scar length, and self-confidence.
  
  
  CONCLUSIONS
  Our surgical workflow in conjunction with the reference technique is safe and shows significant better results in terms of body image and cosmesis than do the reference technique alone. Thus, we recommend its implementation in order to improve outcomes in a cost-effective way. The limitations of the present study should be kept in mind in the elaboration of future studies.
authors.affiliation: Department of Abdominal, Endocrine and Vascular Surgery, St. Vincentius Kliniken, Südendstrasse 32, D-76137 Karlsruhe, Germany. franck.billmann@wanadoo.fr
authors.forename: Franck
authors.initials: F
authors.lastname: Billmann
authors.forename: Therezia
authors.initials: T
authors.lastname: Bokor-Billmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Voigt
authors.forename: Erhard
authors.initials: E
authors.lastname: Kiffner
mesh_terms: D000328:Adult; D001828:Body Image / Q000523:psychology*; D002921:Cicatrix / Q000517:prevention & control / Q000523:psychology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000191:economics; D011795:Surveys and Questionnaires; D013959:Thyroid Diseases / Q000601:surgery*; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics* / Q000592:standards*