Abstract
Background
Open ventral hernia repair (VHR) is associated with postoperative complications and hospital readmissions. A comprehensive Enhanced Recovery after Surgery (ERAS) protocol for VHR contributes to improved clinical outcomes including the rapid return of bowel function and reduced infections. The purpose of this study was to compare hospital costs for patients cared for prior to ERAS implementation with patients cared for with an ERAS protocol.
Methods
With IRB approval, clinical characteristics and postoperative outcomes data were obtained via retrospective review of consecutive VHR patients 2 years prior to and 14 months post ERAS implementation. Hospital cost data were obtained from the cost accounting system inclusive of index hospitalization. Clinical data and hospital costs were compared between groups.
Results
Data for 178 patients (127 pre-ERAS, 51 post-ERAS) were analyzed. Preoperative and operative characteristics including gender, ASA class, comorbidities, and BMI were similar between groups. ERAS patients had faster return of bowel function (p = 0.001) and decreased incidence of superficial surgical site infection (p = 0.003). Hospital length of stay did not vary significantly pre and post ERAS implementation. Inpatient pharmacy costs were increased in ERAS group ($2673 vs. $1176 p < 0.001), but total hospital costs (14,692 vs. 15,151, p = 0.538) were similar between groups.
Conclusions
Standardization of hernia care via ERAS protocol improves clinical outcomes without impacting total costs.
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Dr. Roth discloses he has grant funding from Bard and Miromatrix; he is a consultant for Bard, Johnson & Johnson, and Allergan; and he owns stock in Miromatrix. Mr. Harryman, Drs. Stearns, Plymale, Chang, and Davenport have no conflicts of interest or financial ties to disclose.
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Harryman, C., Plymale, M.A., Stearns, E. et al. Enhanced value with implementation of an ERAS protocol for ventral hernia repair. Surg Endosc 34, 3949–3955 (2020). https://doi.org/10.1007/s00464-019-07166-2
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DOI: https://doi.org/10.1007/s00464-019-07166-2