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.
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
New findings from CREST-2 are providing important evidence on the role of carotid artery stenting (CAS) in patients with severe asymptomatic carotid stenosis — while underscoring the importance of operator experience, patient selection and procedural technique in achieving favorable outcomes.
