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Enhanced REVENUE After Surgery? A Cost-Standardized Enhanced Recovery Pathway for Mastectomy Decreases Length of Stay

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Abstract

Background

Enhanced recovery after surgery (ERAS) protocols have been shown to improve surgical, anesthetic, and economic outcomes in intermediate-to-high-risk surgeries. Its influence on length of stay and cost of low-risk surgeries has yet to be robustly studied. As value-based patient care comes to the forefront of anesthesiology research, the focus shifts to strategies that maintain quality while effectively containing cost.

Methods

In July 2016, we implemented an ERAS for mastectomy protocol consisting of limiting fasting state, preoperative multimodal analgesia, and pectoralis I and II blocks. After 1 year, patient records were retrospectively reviewed for length of stay, opioid consumption, pain scores, and hospital charges.

Results

Implementation of an ERAS protocol for mastectomies led to a decrease in opioid consumption, and statistically significant decrease in length of stay (1.19 vs. 1.44, p = 0.01). No significant change in hospital charges was observed ($25,787 vs. $25,863, p = 0.97); however, the variance of charges was significantly decreased (6.8 × 107 vs. 1.5 × 108, p = 0.002). The decrease in length of stay translated to an extra 100 hospital bed days which can provide up to an additional $2,100,000 in gross patient service revenue from additional mastectomy volume.

Conclusion

ERAS protocols for mastectomies may prove beneficial by allowing growing hospitals to increase bed capacity and consequently surgical volume. Despite no change in hospital charges, we predict a potential increase in gross patient service revenue of $2.1 million due to saved hospital bed days.

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Authors and Affiliations

  1. Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs, Tampa, FL, 33612, USA

    Robert S. Ackerman, Michael Hirschi & Brandon Alford

  2. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Robert S. Ackerman

  3. Department of Anesthesiology, H. Lee Moffitt Cancer, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Trip Evans & Sephalie Y. Patel

  4. Department of Breast Oncology, H. Lee Moffitt Cancer, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    John V. Kiluk

Authors
  1. Robert S. Ackerman
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  2. Michael Hirschi
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  3. Brandon Alford
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  4. Trip Evans
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  5. John V. Kiluk
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  6. Sephalie Y. Patel
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Corresponding author

Correspondence to Sephalie Y. Patel.

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The authors declare that they have no conflict of interests.

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Ackerman, R.S., Hirschi, M., Alford, B. et al. Enhanced REVENUE After Surgery? A Cost-Standardized Enhanced Recovery Pathway for Mastectomy Decreases Length of Stay. World J Surg 43, 839–845 (2019). https://doi.org/10.1007/s00268-018-4850-0

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  • DOI: https://doi.org/10.1007/s00268-018-4850-0

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