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
0 min

Updates In Surgery

Objective:

To evaluate the clinical and economic impact, including cost savings, of an ERAS-based thyroidectomy pathway compared to conventional hospitalization under the Italian National Health Service.

Approach:

Key Findings:

ERAS pathways can reduce length of stay and improve resource utilization without compromising safety, which may lead to better patient outcomes.
Traditional multi-day hospitalizations persist due to reimbursement concerns rather than clinical evidence, impacting patient care.
The Italian DRG system creates financial disincentives for adopting ERAS pathways, hindering potential improvements in surgical efficiency.

Interpretation:

The study highlights a misalignment between reimbursement incentives and the implementation of ERAS protocols in thyroid surgery, affecting the efficiency of public surgical services and potentially compromising patient outcomes.

Limitations:

The analysis was conducted from a hospital/provider perspective, potentially limiting broader applicability; exclusions of complex cases like central neck dissection and redo surgeries may affect generalizability.

Conclusion:

The findings indicate that ERAS-inspired thyroid surgery could enhance efficiency and reduce costs, but structural barriers in the reimbursement system hinder its adoption, necessitating policy changes.