[Controlling in a surgical university clinic exemplified by bilateral thyroid gland resection]

We calculated the overall costs of all patients who had bilateral thyroid resections due to benign diseases between 1995 and 1997 in a process costing analysis. The operating costs for an bilateral thyroid resection were 5205 DM, resulting in a loss of 410 DM/per case. The major cost factors were personnel costs (33%), operating costs on the ward (32%), and shared overhead costs (24%). Consequently, the main efforts for cost reduction were achieved by reducing the hospital stay (12.6 days in 1995 resulting in 7755 DM total costs; 6.3 days in 1988 resulting in 4712 DM). Saving in personnel costs by reducing operating time is not feasible in a university department due to its obligation of training. Overhead costs need to be analysed in detail, because this is a hitherto neglected domain, where costs can be saved without damaging the quality of the surgical therapy.