Enhanced recovery protocols in colonic surgery: retrospective cohort analysis of economic impact from an institutional point of view
- 53 Downloads
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.
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.
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.
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.
KeywordsColorectal surgery Postoperative outcome Enhanced recovery following surgery Economical impact In-hospital stay Perioperative management
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.
- 3.Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught C, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O, Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care, European Society for Clinical Nutrition and Metabolism (ESPEN), International Association for Surgical Metabolism and Nutrition (IASMEN) (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg 37(2):259–284CrossRefGoogle Scholar
- 7.Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Colorectal Cancer Group, editor. Cochrane Database Syst Rev. 2011; [cited 2018 Apr 30]; Available from: https://doi.org/10.1002/14651858.CD007635.pub2
- 14.Roulin D, Donadini A, Gander S, Griesser A-C, Blanc C, Hübner M, Schäfer M, Demartines N (2013) Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery: cost-effectiveness of enhanced recovery protocol for colorectal surgery. Br J Surg 100(8):1108–1114CrossRefGoogle Scholar