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Economic analysis of routine neuromonitoring of recurrent laryngeal nerve in total thyroidectomy / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Economic analysis of routine neuromonitoring of recurrent laryngeal nerve in total thyroidectomy Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2015 Títulos uniformes : Biomédica Idioma : Inglés (eng) Palabras clave : Thyroid gland  thyroidectomy  cost-benefit analysis  meta-analysis Resumen : Introduction: Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. Objective: To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country. Materials and methods: We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. Results: We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Conclusion: Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system. Mención de responsabilidad : Álvaro Sanabria, Adonis Ramírez Referencia : Biomedica. 2015 Jul-Sep;35(3):363-71. DOI (Digital Object Identifier) : 10.7705/biomedica.v35i3.2371 PMID : 26849698 En línea : https://www.revistabiomedica.org/index.php/biomedica/article/view/2371 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3929 Economic analysis of routine neuromonitoring of recurrent laryngeal nerve in total thyroidectomy [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2015. Obra : Biomédica Idioma : Inglés (eng) Palabras clave : Thyroid gland  thyroidectomy  cost-benefit analysis  meta-analysis Resumen : Introduction: Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. Objective: To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country. Materials and methods: We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. Results: We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Conclusion: Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system. Mención de responsabilidad : Álvaro Sanabria, Adonis Ramírez Referencia : Biomedica. 2015 Jul-Sep;35(3):363-71. DOI (Digital Object Identifier) : 10.7705/biomedica.v35i3.2371 PMID : 26849698 En línea : https://www.revistabiomedica.org/index.php/biomedica/article/view/2371 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3929

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The Bethesda system for reporting thyroid cytopathology in Colombia : Correlation with histopathological diagnoses in oncology and non-oncology institutions / Álvaro Enrique Sanabria Quiroga    

Público ISBD Título : The Bethesda system for reporting thyroid cytopathology in Colombia : Correlation with histopathological diagnoses in oncology and non-oncology institutions Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2015 Títulos uniformes : Journal of Cytology Idioma : Inglés (eng) Palabras clave : Bethesda system  biopsy  fine needle  multicenter study  pathology  terminology  thyroid cytopathology  thyroid gland  thyroid neoplasms Resumen : Aim: To determine the correlation between the results of thyroid fine-needle aspirations interpreted using the Bethesda system and final histopathological reports for patients at an oncology hospital (OH) and non-oncology hospitals (NOHs).Materials and Methods: A retrospective, cross-sectional, descriptive study was performed to compare the cytology and histopathology results for patients with thyroid nodules in three Colombian hospitals. The final correlation of diagnoses between the two methods is reported. In Colombia, the health system provides the existence of general care hospitals and hospitals specializing in care of patients with cancer.Results: A total of 196 reports were reviewed, of which 53% were from OH and 47% were from NOHs. A greater proportion of category V (37.5%) was diagnosed at the OH, whereas NOHs diagnosed a greater proportion of category II (42.3%). The global correlation between diagnoses made using cytology and histopathology was 93.3% for categories V and VI (based on the final malignant diagnosis) and 86.9% for benign category II. Significant differences between institution types were observed when category IV and V and malignant histopathology were compared (56.3% OH vs. 23.5% NOH; P = 0.05 for category IV, 97.4% OH vs. 82.3% NOH; P = 0.03 for category V), while no significant difference between institution types was observed when category II and final benign diagnosis were compared (P = 0.6).Conclusions: The Bethesda system for thyroid cytology correlates adequately with final histopathological diagnosis in Colombia. Significant differences were identified in the diagnostic correlation for malignant lesions between the OH and NOHs in categories IV and V caused by selection bias of the population. Mención de responsabilidad : Mario Alexander Melo-Uribe, Álvaro Sanabria, Alfredo Romero-Rojas, Gabriel Pérez, Elga Johanna Vargas, María Claudia Abaúnza, Víctor Gutiérrez Referencia : J Cytol. 2015 Jan-Mar;32(1):12-6. DOI (Digital Object Identifier) : 10.4103/0970-9371.155224. PMID : 25948937 Derechos de uso : CC BY-NC-SA En línea : http://www.jcytol.org/article.asp?issn=0970-9371;year=2015;volume=32;issue=1;spa [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3900 The Bethesda system for reporting thyroid cytopathology in Colombia : Correlation with histopathological diagnoses in oncology and non-oncology institutions [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2015. Obra : Journal of Cytology Idioma : Inglés (eng) Palabras clave : Bethesda system  biopsy  fine needle  multicenter study  pathology  terminology  thyroid cytopathology  thyroid gland  thyroid neoplasms Resumen : Aim: To determine the correlation between the results of thyroid fine-needle aspirations interpreted using the Bethesda system and final histopathological reports for patients at an oncology hospital (OH) and non-oncology hospitals (NOHs).Materials and Methods: A retrospective, cross-sectional, descriptive study was performed to compare the cytology and histopathology results for patients with thyroid nodules in three Colombian hospitals. The final correlation of diagnoses between the two methods is reported. In Colombia, the health system provides the existence of general care hospitals and hospitals specializing in care of patients with cancer.Results: A total of 196 reports were reviewed, of which 53% were from OH and 47% were from NOHs. A greater proportion of category V (37.5%) was diagnosed at the OH, whereas NOHs diagnosed a greater proportion of category II (42.3%). The global correlation between diagnoses made using cytology and histopathology was 93.3% for categories V and VI (based on the final malignant diagnosis) and 86.9% for benign category II. Significant differences between institution types were observed when category IV and V and malignant histopathology were compared (56.3% OH vs. 23.5% NOH; P = 0.05 for category IV, 97.4% OH vs. 82.3% NOH; P = 0.03 for category V), while no significant difference between institution types was observed when category II and final benign diagnosis were compared (P = 0.6).Conclusions: The Bethesda system for thyroid cytology correlates adequately with final histopathological diagnosis in Colombia. Significant differences were identified in the diagnostic correlation for malignant lesions between the OH and NOHs in categories IV and V caused by selection bias of the population. Mención de responsabilidad : Mario Alexander Melo-Uribe, Álvaro Sanabria, Alfredo Romero-Rojas, Gabriel Pérez, Elga Johanna Vargas, María Claudia Abaúnza, Víctor Gutiérrez Referencia : J Cytol. 2015 Jan-Mar;32(1):12-6. DOI (Digital Object Identifier) : 10.4103/0970-9371.155224. PMID : 25948937 Derechos de uso : CC BY-NC-SA En línea : http://www.jcytol.org/article.asp?issn=0970-9371;year=2015;volume=32;issue=1;spa [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3900

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Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2013 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroid gland  laryngeal nerve injuries  neuromuscular monitoring  thyroidectomy  tracheostomy Resumen : One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Carlos Suárez, Ashok Shaha, Avi Khafif, Randall P Owen, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. DOI (Digital Object Identifier) : 10.1007/s00405-013-2558-1 PMID : 23685965 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2558-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3713 Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2013. Obra : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroid gland  laryngeal nerve injuries  neuromuscular monitoring  thyroidectomy  tracheostomy Resumen : One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Carlos Suárez, Ashok Shaha, Avi Khafif, Randall P Owen, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. DOI (Digital Object Identifier) : 10.1007/s00405-013-2558-1 PMID : 23685965 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2558-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3713

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