Evaluation and Monitoring of the Clinical Pathway for Thyroidectomy

Abstract

The aim of this study is to present the evaluation and monitoring of a clinical pathway for thyroidectomy 1 year after its implementation and after 4 years’ follow up. We compare the results of an evaluation and monitoring indicators series before and after the establishment of the clinical pathway for thyroidectomy in the Surgery Department of Morales Meseguer Hospital, a general university hospital in Murcia, Spain. Implementation of the clinical pathway led to a reduction in length of hospital stay for all the surgery patients (4.8 ± 2.1 and 3.6 ± 1.9 days before and after pathway implementation, respectively; P < 0.001). Implementation of the clinical pathway led to a reduction in cost in all the operated patients (3357 ± 966 and 2695 ± 970 US$ before and after implementing the clinical pathway, respectively; P < 0.001). Evolution of the mean hospital cost according to year of study shows a reduction from 2000 (3400 ± 1056 US$) to 2004 (2404 ± 666 US$) with a slight increase during 2005 (2721 ± 1335 US$) (P < 0.001). Implementation of the clinical pathway for thyroidectomy has successfully reduced clinical variation and therefore the length of hospital stay and mean cost of the process. In subsequent years, no such major improvements have been made with regard to hospital stay, although they are still clearly better than those before pathway implementation.

Cost-Effectiveness of Using a Molecular Diagnostic Test to Improve Preoperative Diagnosis of Thyroid Cancer

“…Indirect costs for total thyroidectomy or hemithyroidectomy were calculated on the basis of average lengths of hospitalizations subsequent to those surgeries and assuming an average income of $99 per day. We calculated the average annual income of men and women on the basis of US census data and assuming that 12% of the patients were men [16]. Our estimation of average income per day is also consistent with the findings from other studies including Wang et al [17].…”

“…A heath state utility value (six-dimensional health state short form [derived from short form 36 health survey]) was assigned to each health state to facilitate the calculation of quality-adjusted lifeyears (QALYs) as the final model outcome [20]. For each individual in the model, QALYs were calculated by multiplying the utility values of each health state with the time spent in that health state throughout the model [16].…”

“…The cost of the DX test was assumed to include costs of all related procedures including pathology, physician time, and specimen transport and processing. Direct costs for total thyroidectomy or hemithyroidectomy in our study were based on the results from Soria-Aledo et al [16]. Indirect costs for total thyroidectomy or hemithyroidectomy were calculated on the basis of average lengths of hospitalizations subsequent to those surgeries and assuming an average income of $99 per day.…”

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta‐analysis

“…The studies were published from 2000 to 2020. Three studies were performed in the United States, [15][16][17] while the remaining were conducted in Singapore, 18 Spain, 19 Korea, 20 and the United Kingdom. 21 All studies employed a prospective cohort design, of which 6 used a historical cohort as a representation of traditional perioperative management.…”

A simulation-based modeling framework to deal with Clinical Pathways

“…First this procedure fits most of the selection criteria suggested by Zander and Bower (1987) recalled above. Secondly, recent studies suggest that clinical pathways for this procedure have the potential to reduce length of stay and limit variability in care, thereby yielding cost savings (Kulkarni et al 2011;Ramanujam and Cheah 2005;Soria-Aledo et al 2008).…”