TY - JOUR
T1 - Economic Impact of Frozen Section for Thyroid Nodules with “Suspicious for Malignancy” Cytology
AU - Bollig, Craig A.
AU - Gilley, David
AU - Lesko, David
AU - Jorgensen, Jeffrey B.
AU - Galloway, Tabitha L.
AU - Zitsch, Robert P.
AU - Dooley, Laura M.
N1 - Publisher Copyright:
© 2017, © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2017.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Objective: To perform a cost analysis of the routine use of intraoperative frozen section (iFS) among patients undergoing a thyroid lobectomy with “suspicious for malignancy” (SUSP) cytology in the context of the 2015 American Thyroid Association guidelines. Study Design: Case series with chart review; cost minimization analysis. Setting: Academic. Subjects and Methods: Records were reviewed for patients with SUSP cytology who underwent thyroid surgery between 2010 and 2015 in which iFS was utilized. The diagnostic test performance of iFS and the frequency of indicated completion/total thyroidectomies based on the 2015 guidelines were calculated. A cost minimization analysis was performed comparing lobectomy, with and without iFS, and the need for completion thyroidectomy according to costs estimated from 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. Results: Sixty-five patients met inclusion criteria. The malignancy rate was 61.5%, 45% of which was identified intraoperatively. The specificity and positive predictive value were 100%. The negative predictive value and sensitivity were 83% and 95%, respectively. Completion/total thyroidectomy was indicated for 9% of patients; 83% of these individuals had findings on iFS that would have changed management intraoperatively. Application of the new guidelines would have resulted in a significant reduction in the frequency of conversion to a total thyroidectomy when compared with the actual management (26.1% vs 7.7%, P =.005). Performing routine iFS was the less costly scenario, resulting in a savings of $474 per case. Conclusion: For patients with SUSP cytology undergoing lobectomy, routine use of iFS would result in decreased health care utilization.
AB - Objective: To perform a cost analysis of the routine use of intraoperative frozen section (iFS) among patients undergoing a thyroid lobectomy with “suspicious for malignancy” (SUSP) cytology in the context of the 2015 American Thyroid Association guidelines. Study Design: Case series with chart review; cost minimization analysis. Setting: Academic. Subjects and Methods: Records were reviewed for patients with SUSP cytology who underwent thyroid surgery between 2010 and 2015 in which iFS was utilized. The diagnostic test performance of iFS and the frequency of indicated completion/total thyroidectomies based on the 2015 guidelines were calculated. A cost minimization analysis was performed comparing lobectomy, with and without iFS, and the need for completion thyroidectomy according to costs estimated from 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. Results: Sixty-five patients met inclusion criteria. The malignancy rate was 61.5%, 45% of which was identified intraoperatively. The specificity and positive predictive value were 100%. The negative predictive value and sensitivity were 83% and 95%, respectively. Completion/total thyroidectomy was indicated for 9% of patients; 83% of these individuals had findings on iFS that would have changed management intraoperatively. Application of the new guidelines would have resulted in a significant reduction in the frequency of conversion to a total thyroidectomy when compared with the actual management (26.1% vs 7.7%, P =.005). Performing routine iFS was the less costly scenario, resulting in a savings of $474 per case. Conclusion: For patients with SUSP cytology undergoing lobectomy, routine use of iFS would result in decreased health care utilization.
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U2 - 10.1177/0194599817740328
DO - 10.1177/0194599817740328
M3 - Article
C2 - 29292662
AN - SCOPUS:85041613527
SN - 0194-5998
VL - 158
SP - 257
EP - 264
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 2
ER -