title: Hospital costs associated with thyroidectomy performed with a Harmonic device compared to conventional techniques: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Harmonic devices have become a world-wide standard for dissection and hemostasis in thyroidectomy. Numerous systematic reviews have reported superior operating times, blood loss, post-operative pain, length of stay, and overall safety outcomes. What has not been extensively evaluated in a robust manner is their economic impact. The purpose of this study is to evaluate the hospital costs associated with open thyroidectomy using Harmonic devices compared with conventional techniques for hemostasis.
  
  
  METHODS
  A systematic review of Medline, Scopus, and CENTRAL was performed from January 1, 2000 to May 23, 2014 without language restrictions for randomized clinical trials comparing Harmonic surgical devices to conventional methods in thyroidectomy. The main outcome measure was total reported costs. Costs were pooled using the ratio of means and a random effects model. Sensitivity analyses assessed whether differences in patient and trial characteristics, healthcare setting, or choice of statistical model affected outcomes.
  
  
  RESULTS
  Seven studies met the inclusion criteria. A total of 476 participants had procedures performed with Harmonic devices and 478 with conventional monopolar electrosurgery and clamp, cut and tie techniques. Compared with conventional techniques, Harmonic devices reduced total reported costs by 10% (p = 0.007), resulting in a $229 US dollars (USD) absolute reduction from mean baseline costs. Results remained relatively robust to additional sensitivity analyses.
  
  
  CONCLUSIONS
  This systematic review and meta-analysis demonstrates that the Harmonic family of surgical devices is associated with a reduction in total reported costs in thyroidectomy compared with conventional techniques. A large portion of the overall savings derives from a reduction in operative costs.
authors.affiliation: a Ethicon Inc. , Cincinnati , OH , USA ;
authors.forename: Hang
authors.initials: H
authors.lastname: Cheng
authors.affiliation: b Cornerstone Research Group , Burlington , ON , Canada.
authors.forename: Ireena M
authors.initials: IM
authors.lastname: Soleas
authors.affiliation: b Cornerstone Research Group , Burlington , ON , Canada.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Ferko
authors.affiliation: b Cornerstone Research Group , Burlington , ON , Canada.
authors.forename: Chris G
authors.initials: CG
authors.lastname: Cameron
authors.affiliation: a Ethicon Inc. , Cincinnati , OH , USA ;
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Clymer
authors.affiliation: a Ethicon Inc. , Cincinnati , OH , USA ;
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Amaral
mesh_terms: D016063:Blood Loss, Surgical; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D017059:Models, Econometric; D009873:Operating Rooms / Q000191:economics; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology; D010561:Personnel Staffing and Scheduling / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D013525:Surgical Instruments / Q000191:economics*; D013965:Thyroidectomy / Q000191:economics* / Q000295:instrumentation*
keywords: Costs; Harmonic scalpel; Meta-analysis; Thyroidectomy