The Effect of Clinical Pathway Implementation on Total Hospital Costs for Thyroidectomy and Parathyroidectomy Patients

Markey, Donna W.; McGowan, Jim; Hanks, John B.
June 2000
American Surgeon;Jun2000, Vol. 66 Issue 6, p533
Academic Journal
Clinical pathways have long been used to guide the delivery of patient care in varied practice settings. There is little information in the literature to document the effectiveness of pathway implementation in general surgical populations. This study reports the effect of clinical pathway implementation in two general surgical patient groups, thyroidectomy and parathyroidectomy. Clinical pathways were implemented to serve patients undergoing thyroidectomy and parathyroidectomy surgery. The effects of both clinical pathways on total hospital costs, length of hospitalization, variances, and outcomes were collected and evaluated from July 1998 through July 1999. These data were compared to data from the previous year. The average length of stay for parathyroidectomy patients decreased from 2.4 to 1.5 days (P = 0.26) for pathway patients as compared to prepathway patients. The average cost per case decreased from $5071 to $4291 (P = 0.50) for parathyroidectomy pathway versus prepathway patients. The average length of stay decrease for thyroidectomy patients was 1.4 to 1.2 (P = 0.16) for the pathway to prepathway comparison. The average cost per case decrease was minor at $4117 to $4111. Pharmacy costs and laboratory utilization were effectively reduced. Perioperative costs rose dramatically during this period, operating room/central sterile supply cost per case rose 12 per cent, anesthesia supply cost per case rose 15 per cent, and surgical pathology costs increased 110 per cent overall for both patient groups. Clinical pathway implementation has allowed us to reduce or maintain total hospital costs in the face of rising perioperative costs. We conclude that implementation of these clinical pathways has allowed us to improve consistency with which we deliver care while maintaining the quality of patient outcomes and reducing the costs of care and length of hospital stay.


Related Articles

  • Minimally Invasive Video-Assisted Thyroidectomy and Parathyroidectomy with Intraoperative Recurrent Laryngeal Nerve Monitoring. Dionigi, Gianlorenzo; Boni, Luigi; Rausei, Stefano // International Journal of Otolaryngology;2010, p1 

    A letter to the editor is presented in response to the article "Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring," by E. Kandil and colleagues in the 2009 issue.

  • Dangerous minimally invasive surgery: correct proposal. Karakas, Elias; Steinfeldt, Thorsten; Gockel, Andreas; Westermann, Reiner; Bartsch, Detlef K. // Surgical Endoscopy;Aug2011, Vol. 25 Issue 8, p2771 

    A response by Elias Karakas and colleagues to a letter to the editor about their article "Transoral Thyroid and Parathyroid Surgery" in the 2010 issue is presented.

  • Endoscopic Parathyroidectomy and Thyroidectomy. Gagner, Michel // Seminars in Laparoscopic Surgery;Dec1997, Vol. 4 Issue 4, p235 

    After successful animal experimentation and exploration of multiple techniques of endoscopic thyroidectomy and parathyroidectomies in 1994, I performed the first successfull endoscopic subtotal parathyroidectomy in a 37-year-old man for primary hyperparathyroidism in 1995. Subsequently,...

  • Invisible Scar Endoscopic Dorsal Approach Thyroidectomy: A Clinical Feasibility Study. Donatini, G.; Materazzi, G.; Miccoli, P. // World Journal of Surgery;Sep2011, Vol. 35 Issue 9, p2177 

    The article offers the authors' insights on the article by doctor HM Schardey and colleagues regarding endoscopic dorsal approach for thyroidectomy. The authors point out that endoscopic procedures and open surgery should be simple and easy. They question the necessity for serum calcium and...

  • Joint Meeting of the German Association of Endocrine Surgeons (CAEK) and the British Association of Endocrine and Thyroid Surgeons (BAETS).  // Langenbeck's Archives of Surgery;Nov2016, Vol. 401 Issue 7, p1045 

    The article presents several abstracts including which include the result of surgery after loss of signal during thyroidectomy, thyroid cancers revealed by metastases, and hypocalcaemia management in post parathyroidectomy in renal patients.

  • Permanent hypocalcemia in patients operated for thyroid carcinoma. Turanli, Sevim; Karaman, Niyazi; Ozgen, Kubilay // Indian Journal of Otolaryngology & Head & Neck Surgery;Oct-Dec2009, Vol. 61 Issue 4, p280 

    Aim and objective The incidence and risk factors for permanent hypocalcemia in thyroid carcinoma were investigated. Materials and methods The records of 417 patients were reviewed retrospectively at tertiary oncology referral center. Total or subtotal thyroidectomy patients constituted group I...

  • Thyroidectomy and parathyroidectomy: a guide for patients. Giddings, A. E. B. // Journal of the Royal Society of Medicine (Supplement);Jan1998, Vol. 91 Issue 33, p33 

    The article offers information on thyroidectomy and parathyroidectomy. Clinical examination and other tests used in the diagnosis of enlargement or malfunctions of the thyroid include blood tests of function, fine needle aspiration biopsy, ultrasound examination and computerized tomography...

  • Safe thyroidectomy with intraoperative methylene blue spraying. Sari, Serkan; Aysan, Erhan; Muslumanoglu, Mahmut; Ersoy, Yeliz E.; Bektasoglu, Huseyin; Yardimci, Erkan // Thyroid Research;2012, Vol. 5 Issue 1, p15 

    Background: We aimed to minimalize operative complications by spraying of methylene blue stain on thyroid glands and the perithyroidal area. Material and methods: The intra-operative methylene blue spraying technique was used prospectively on a total of 56 patients who had undergone primary (not...

  • What is the Evidence Base for Video Assisted Endoscopic Surgery for Thyroidectomy and Parathyroidectomy. Agrawal, Namit // Internet Journal of Otorhinolaryngology;2005, Vol. 3 Issue 2, p6 

    The article informs about what is the evidence base for video assisted endoscopic surgery for thyroidectomy and parathyroidectomy.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics