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

21 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


Dive into the research topics of 'Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste'. Together they form a unique fingerprint.

Cite this