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Introducing routine intraoperative nerve monitoring in a high-volume endocrine surgery centre: a health technology assessment

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Abstract

We sought to analyse the effect of the introduction of intraoperative nerve monitoring (IONM) in our routine surgical practice and to provide a circumstantial analysis of direct costs of IONM in total thyroidectomy and of indirect costs associated with vocal fold palsy, as centred in the health care system of Italy. We retrospectively compared outcomes of 232 total thyroidectomies performed between November 2017 and October 2019, respectively, before (109 TT-Group A) and after (123 TT-Group B) adopting IONM technology in November 2018. We analysed the costs of IONM per procedure and rate and costs of vocal fold palsy events (temporary and permanent). Overall, there were 61 thyroid cancers (32 in Group B) and 171 multinodular goitres (91 in Group B). We recorded 5 cases of vocal fold palsy (4.6%—4 transient, 1 permanent) in Group A and none in Group B (p = 0.016). IONM consumables cost 219 eur per case. Healthcare and social cost of Vocal fold palsy ranged between 3200 eur (function recovery < 1 month postoperatively) and over 32,000 eur (permanent event). When only direct costs are considered, IONM can hardly be cost effective. In this study, cost of IONM implementation was offset by the absence of complications attributable to recurrent laryngeal nerve dysfunction.

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Data availability

Original population and Patients’ data supporting this study are available upon request from the Department of Biomedical Sciences and Human Oncology—Academic Unit of General Surgery “Bonomo” In this study, cost of intraoperative neuromonitoring implementation was offset by the absence of complications attributable to recurrent laryngeal nerve dysfunction.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Academic General Surgery Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro” Medical School, 11, Piazza Giulio Cesare, 70124, Bari, BA, Italy

    Francesco Paolo Prete, Lucia Ilaria Sgaramella, Giovanna Di Meo, Alessandro Pasculli, Giovanna Calculli, Angela Gurrado & Mario Testini

  2. Hospital Administration, Strategic planning, Policlinico Di Bari University Hospital, Bari, Italy

    Gianluigi Protopapa

Authors
  1. Francesco Paolo Prete
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  2. Lucia Ilaria Sgaramella
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  3. Giovanna Di Meo
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  4. Alessandro Pasculli
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  5. Giovanna Calculli
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  6. Gianluigi Protopapa
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Contributions

All the authors read and approved the final manuscript version to be published. Conception: FPP. Methodology: AG, FPP, MT. Formal analysis and investigation: FPP, GDM, AP, LIS, GC, GP. Writing—original draft preparation: FPP. Writing—review and editing: FPP, GDM, AP, LIS. Supervision: MT.

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Correspondence to Francesco Paolo Prete.

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No conflicts of interest exist.

Ethics approval

This research has been performed in accordance with the declaration of Helsinki. The study was approved by the Institutional Review Board of the University Medical School of Bari; all patients gave a written consent to the use of data for research.

Consent to participate and for publication

Patient consent for research uses of data was obtained for each case presented. All identification data of the patients were removed from medical records prior to data collection. De-identified data were used, and it was not possible to trace any of the data to actual individuals. Only information required for coherent description of cases was extracted. Data in electronic format were accessible to authorised personnel only. Consent was given for the publication of intraoperative pictures.

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Prete, F.P., Sgaramella, L.I., Di Meo, G. et al. Introducing routine intraoperative nerve monitoring in a high-volume endocrine surgery centre: a health technology assessment. Updates Surg 73, 2263–2273 (2021). https://doi.org/10.1007/s13304-021-01104-5

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  • DOI: https://doi.org/10.1007/s13304-021-01104-5

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