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International Journal of Colorectal Disease

, Volume 34, Issue 2, pp 301–307 | Cite as

Enhanced recovery protocols in colonic surgery: retrospective cohort analysis of economic impact from an institutional point of view

  • Amel Benbouzid
  • Nicolas Tabchouri
  • Christine Denet
  • Jean-Marc Ferraz
  • Anais Laforest
  • Brice Gayet
  • Candice Tubbax
  • Pascal Paubel
  • Ariane d’Avout d’Auerstaedt
  • Anne-Elisabeth Bossard
  • Anthony Sarran
  • Isabelle Aminot
  • Sandra Camps
  • David FuksEmail author
Original Article
  • 53 Downloads

Abstract

Background

Despite increasing evidence supporting the beneficial effects of enhanced recovery protocols (ERPs), their accurate economic impact on institutions remains lacking. The aim of this study was to analyze ERP economic impact in a French center in order to further encourage implementation.

Methods

All patients who underwent elective laparoscopic right or left colectomy for benign or malignant pathology from 2014 to 2017 in a single center were retrospectively reviewed. ERP according to national recommendations was effective starting November 2015. Perioperative data and all direct costs borne by the institution were collected for each patient. Patients who underwent colectomy before and after ERP implementation were compared.

Results

Overall, 288 patients were included of which 144 received conventional perioperative care (CC) and 144 received ERP. There were 161 (56%) men, median age was 71 (28–92) years, and 242 (84%) patients underwent surgery for malignant disease. Operative time, intraoperative blood loss, and severe postoperative complications were similar between both groups. ERP was associated with reduced Clavien-Dindo I–II postoperative complications (15% vs. 28%, p = 0.010) and overall in-hospital stay (6 vs. 7 days, p = 0.003). Overall institutional costs were lower in the ERP group although difference was not statistically significant (7022 vs. 7501 euros, p = 0.098). Estimated savings per patient reached a mean of 480 euros.

Conclusions

In a tertiary French center, ERP was associated with reduced postoperative morbidity and in-hospital stay resulting in considerable cost savings. Although not significant, ERP resulted in positive economic impact even in an early implementation phase.

Keywords

Colorectal surgery Postoperative outcome Enhanced recovery following surgery Economical impact In-hospital stay Perioperative management 

Notes

Compliance with ethical standards

This study was approved by the local institutional review board.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Amel Benbouzid
    • 1
    • 2
  • Nicolas Tabchouri
    • 2
  • Christine Denet
    • 2
  • Jean-Marc Ferraz
    • 2
  • Anais Laforest
    • 2
  • Brice Gayet
    • 2
  • Candice Tubbax
    • 2
  • Pascal Paubel
    • 3
  • Ariane d’Avout d’Auerstaedt
    • 2
  • Anne-Elisabeth Bossard
    • 4
  • Anthony Sarran
    • 5
  • Isabelle Aminot
    • 6
  • Sandra Camps
    • 1
  • David Fuks
    • 2
    Email author
  1. 1.Department of PharmacyInstitut Mutualiste MontsourisParisFrance
  2. 2.Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste MontsourisUniversité Paris DescartesParisFrance
  3. 3.Health Law Institute, INSERM UMR S1145Paris Descartes UniversityParisFrance
  4. 4.Department of AnesthesiologyInstitut Mutualiste MontsourisParisFrance
  5. 5.Department of RadiologyInstitut Mutualiste MontsourisParisFrance
  6. 6.Department of Medical informationInstitut Mutualiste MontsourisParisFrance

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