Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste

Lilah F. Morris, Minerva A Romero Arenas, Jeffrey Cerny, Joel S. Berger, Connie M. Borror, Meagan Ong, Ashley K. Cayo, Paul H. Graham, Elizabeth G. Grubbs, Jeffrey E. Lee, Nancy D. Perrier

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Background. We assessed the efficiency, consistency, and appropriateness of perioperative processes for standard (total) thyroidectomy and devised a valuable strategy to decrease variability and waste. Methods. Our multidisciplinary team evaluated <23-hour stay standard thyroidectomy performed by 3 surgical endocrinologists. We used the nominal group technique, process flowcharts, and root cause analysis to evaluate 6 perioperative processes. Anticipated decreases in costs, charges, and resources from improvements were calculated. Results. Median total charge for standard thyroidectomy was $27,363 (n = 80; $48,727 variation). Perioperative coordination between surgery and anesthesia clinics could eliminate unnecessary testing (potential decrease in charges of $1,505). Nonoperating room time was less in the outpatient operating room (43 vs 52 minutes; P <.001). Consistent scheduling could decrease charges by $585.49 per case. By decreasing 20% of nondisposable instruments on the surgical tray, we could decrease sterile processing costs by $13.30 per case. Modification of postoperative orders could decrease charges by $643 per patient. Overall, this comprehensive analysis identified an anticipated decrease in cost/charge of >$200,000 annually. Conclusion. Perioperative process analyses revealed wide variability for a single, presumed uniform procedure. Systematic assessment helped to identify opportunities to improve efficiency, decrease unnecessary waste and procedures/instrument usage, and focus on patient-centered, quality care. This multidisciplinary strategy could substantially decrease costs/charges for common operative procedures.

Original languageEnglish (US)
Pages (from-to)1441-1449
Number of pages9
JournalSurgery (United States)
Issue number6
StatePublished - 2014

ASJC Scopus subject areas

  • Surgery


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