ERAS thyroidectomy within the Italian DRG-based public health system: surgical efficiency is penalized
By
Francesco Brucchi
Carla Colombo
Pietro Paolo Bianchi
Giuseppe Mercante
Diego Barbieri
Davide Lombardi
Giuseppe Spriano
Mario Bussi
Leone Giordano
Luigi Boni
Piergiorgio Danelli
Luca Persani
Gabriele Materazzi
Paolo Miccoli
Renzo Dionigi
Gianlorenzo Dionigi
June 3, 2026
Clinical Scorecard: Thyroidectomy in the Italian DRG-Based Public Health System: Challenges to Surgical Efficiency in ERAS Implementation
At a Glance
Category Detail
Condition Thyroidectomy Key Mechanisms Enhanced Recovery After Surgery (ERAS) principles integrating multimodal strategies for recovery and complication reduction. Target Population Adult patients undergoing hemithyroidectomy or total thyroidectomy. Care Setting Italian public hospitals under the Servizio Sanitario Nazionale (SSN).
Key Highlights
ERAS pathways can reduce length of stay and improve resource utilization. Traditional multi-day hospitalizations persist due to concerns over postoperative complications. Private providers have adopted early discharge models more readily than public hospitals. Economic implications of ERAS in thyroid surgery have not been systematically evaluated. The study evaluates clinical and economic impacts of ERAS compared to conventional hospitalization. Guideline-Based Recommendations
Diagnosis
Management
Implement standardized preoperative patient education and informed consent. Utilize routine intraoperative neuromonitoring and advanced energy-based hemostatic devices. Monitoring & Follow-up
Early PTH measurement and algorithm-driven calcium and vitamin D supplementation. Structured surveillance during the first 5–6 postoperative hours. Risks
Postoperative hemorrhage and hypocalcemia remain concerns despite ERAS implementation. Patient & Prescribing Data
Adult patients undergoing hemithyroidectomy or total thyroidectomy in a high-volume endocrine surgery unit.
ERAS pathway includes early mobilization, oral intake, and predefined discharge criteria.
Clinical Best Practices
Adopt a structured, multimodal ERAS protocol for thyroid surgery. Ensure comprehensive discharge documentation and follow-up scheduling. Related Resources & Content
