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Adoption of an Enhanced Recovery After Surgery Protocol Increases Cost of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy and Does not Improve Outcomes

  • Peritoneal Surface Malignancy
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Abstract

Background

Enhanced recovery after surgery (ERAS) protocols have been shown to reduce length of stay (LOS) and complications. The impact of ERAS protocols on the cost of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has not been studied.

Patients and Methods

We performed a retrospective cohort analysis of patients undergoing CRS-HIPEC from 2016–2022 at a single quaternary center. Propensity score matching was used to create pre-and post-ERAS cohorts. Cost, overall and serious complications, and intensive care unit (ICU) length of stay (LOS) between the two cohorts were compared using the Mann–Whitney U-test for continuous variables and χ2 test for categorical variables.

Results

Our final matched cohort consisted of 100 patients, with 50 patients in both the pre- and post-ERAS groups. After adjusting for patient complexity and inflation, the median total cost [$75,932 ($67,166–102,645) versus $92,992 ($80,720–116,710), p = 0.02] and operating room cost [$26,817 ($23,378–33,121) versus $34,434 ($28,085-$41,379), p < 0.001] were significantly higher in the post-ERAS cohort. Overall morbidity (n = 22, 44% versus n = 17, 34%, p = 0.40) and ICU length of stay [2 days (IQR 1–3) versus 2 days (IQR 1–4), p = 0.70] were similar between the two cohorts. A total cost increase of $22,393 [SE $13,047, 95% CI (−$3178 to $47,965), p = 0.086] was estimated after implementation of ERAS, with operating room cost significantly contributing to this increase [$8419, SE $1628, 95% CI ($5228–11,609), p < 0.001].

Conclusions

CRS-HIPEC ERAS protocols were associated with higher total costs due to increased operating room costs at a single institution. There was no significant difference in ICU LOS and complications after the implementation of the ERAS protocol.

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Acknowledgement

The authors would like to acknowledge the following individuals who aided in data collection: Isabella Florissi, Nolan Winicki, and Benjamin Shou. Shannon N. Radomski received financial support from National Cancer Institute (NCI) grant 5T32CA126607-12 and the American College of Surgeons Resident Research Scholarship.

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  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Yusuf Ciftci BS, Shannon N. Radomski MD, Blake A. Johnson BS, Fabian M. Johnston MD, MHS & Jonathan B. Greer MD

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Correspondence to Jonathan B. Greer MD.

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Shannon N. Radomski received financial support from National Cancer Institute (NCI) grant 5T32CA126607-12 and the American College of Surgeons Resident Research Scholarship.

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Ciftci, Y., Radomski, S.N., Johnson, B.A. et al. Adoption of an Enhanced Recovery After Surgery Protocol Increases Cost of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy and Does not Improve Outcomes. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15320-x

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