Authors (including presenting author) :
Lim JJM (1), Kwan WYW (2), Chow TL (1)
Affiliation :
(1) Department of Surgery, United Christian Hospital, (2) Strategy & Planning Division, Hospital Authority Head Office
Introduction :
Day-Surgery (DS) hemithyroidectomy can be performed under either general anaesthesia (GA) or local anaesthesia (LA) with comparable outcomes. There is no local data on the cost of DS hemithyroidectomy with respect to the mode of anaesthesia.
Objectives :
This study aims to find out the mode of anaesthesia that could incur a lower cost in DS hemithyroidectomy from the hospital’s perspective. This has tremendous implications on the prioritization of hospital resources usage.
Methodology :
Electronic medical records of all patients with hemithyroidectomy performed in United Christian Hospital between January 2011 and March 2016 were retrospectively reviewed. Data on the mode of anaesthesia, operative times, anaesthetic drugs used, ranks of staff, time to discharge, complications, etc. were retrieved. Unit cost of each item was measured and valued using information from various hospital departments and published data. Bottom-up approach was used to compute the total perioperative costs from the booking of the operation till patients’ discharge from hospital. The average total costs of one DS hemithyroidectomy in the GA group and LA group were compared and analyzed. Sensitivity analyses were performed by varying the costs of LA and GA drugs, salaries of doctors and theatre costs. The influence of one additional overnight hospital stay was assessed.
Result & Outcome :
The average total cost of a DS hemithyroidectomy performed under LA was lower than with GA (HK$ 12,167 versus HK$ 17,543, difference = HK$ 5,376, 95% CI HK$ 4,281 to HK$ 6,470, p=0.038). The extra costs incurred in GA group included salaries of anaesthetists, referral to other specialties for preoperative consultation, longer recovery time in Day Surgery Center, additional laboratory tests and slightly longer total operating theatre time. The total costs were robust to variations in the costs of GA drugs and LA drugs. When one additional overnight stay was needed, the total costs increased by 38% in the LA group and 27% in the GA group. Performing DS hemithyroidectomy under LA is a more cost-saving strategy from the hospital’s perspective. The projected annual cost reduction is HK$ 268,800 in our local department. Judicious selection of suitable patients for LA day surgery hemithyroidectomy is crucial to avoid resource wastage and life-threatening complications.
