Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy

Abstract

Use of IONM is cost-effective in patients undergoing bilateral thyroid surgery.

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

“…A few papers have addressed the issue of costs and benefits in neuromonitoring in thyroid surgery (20)(21)(22)(23). A detailed evaluation of the costs of IONM should include not merely those of the equipment and disposables (electrodes, probes, etc.)…”

“…A detailed evaluation of the costs of IONM should include not merely those of the equipment and disposables (electrodes, probes, etc.) but also that of training, learning curve, nerve early and definitive identification, the aid in nerve dissection, the continuous nerve function evaluation, cataloging anatomy variability, intraoperative surgical strategy and synchronization of surgical maneuvers, injury mapping, the cost of responding to a IONM warning (false vs. true signals), the EBSLN identification and monitoring, teaching tool, IONM use in less experience surgeons, legal issues and the research imprint (20)(21)(22)(23).…”

“…From a purely economic standpoint, benefits of IONM generally include the avoidance of RLN complications in terms of both rehabilitation costs, prevention of bilateral nerve injury, severe permanent injury, selective use, and economic compensation for malpractice lawsuits (20)(21)(22)(23).…”

“…Although most of the papers published conclude that benefits slightly outweigh costs, it is obvious that the cost for each monitored procedure decreases along with the increasing number of cases monitored at a single institution (1,(20)(21)(22)(23).…”

Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery

“…To be cost-effective, all indirect costs of RLN injuries, including speech therapy, repeat laryngeal examinations, VF surgery, and legal claims, must be factored into the costeffectiveness equation. A most recent analysis validated IONM utilization as a cost-effective measure in patients undergoing bilateral thyroidectomy (56). Inpatient costs for all forms of thyroidectomy, regardless of the equipment used, continue to be underfunded.…”