|
Back to 2016 Annual Meeting
Enhanced Recovery After Colorectal Surgery: Does It Make Cents?
Jamie C. Harris*2, Jill Smolevitz2, Amanda P. Tosto3, Jennifer Poirier2, Bruce Orkin1, Joanne Favuzza1
1Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, IL; 2General Surgery, Rush University Medical Center, Chicago, IL; 3Performance Improvement and Clinical Effectiveness, Rush University Medical Center, Chicago, IL
Introduction: Enhanced recovery after surgery (ERAS) protocols in elective colorectal surgery have been shown to decrease length of stay, surgical site infections, and readmission rates. We hypothesize that our ERAS protocol not only improves patient outcomes, but also is more cost effective.
Methods: An ERAS protocol was implemented at a single center in January 2015 for patients undergoing elective colorectal surgery. Prospective data including length of stay and surgical site infections were collected from January 2015 to June 2015. We also obtained hospital cost data which included total cost of hospitalization, as well as itemized costs: blood, cardiology costs, imaging, laboratory utilization, nursing unit costs, pharmacy, physical and occupational therapy, and surgical services. The ERAS group was then compared to patients who underwent elective colorectal surgery from January 2013 until November 2014 prior to implementation of the ERAS protocol (non-ERAS). Analysis was done using Wilcoxon rank-sum tests to examine differences in costs and Fligner-Killeen tests to examine differences in variances; p<0.05 was significant.
Results: A total of 72 patients ERAS patients and 192 non-ERAS patients were identified. Our ERAS patients were found to have decreased length of stay, superficial site infections as well as deep organ space infections (p<0.001-0.02). The mean total direct hospital costs were significantly less for ERAS patients, at an average cost savings of ,690 (p<0.001). The highest recorded total cost for the ERAS group was ,290 which is notably less from the non-ERAS group, which was ,770. The individual cost categories per patient was also significantly lower for ERAS patients compared to non-ERAS patients (p<0.001-0.02) (Table 1). Finally, the variability of cost within the ERAS group was less than non-ERAS, indicating higher costs and unpredictability in the non-ERAS group (p<0.001).
Discussion: In conclusion, we have demonstrated that a dedicated ERAS protocol not only improves patient outcomes, but also results in significant hospital cost savings.
Table 1. Cost comparisons between ERAS and Non-ERAS groups by department.
| | Mean | Mean | Median | Median | Adjusted p-value | | | ERAS | Non-ERAS | ERAS | Non-ERAS | | | Blood | | | | | <0.001 | | Cardiology | | | C:\inetpub\wwwroot\WebsiteHosting\SSAT\website\meetings\abstracts\2016\Tu1811.cgi | C:\inetpub\wwwroot\WebsiteHosting\SSAT\website\meetings\abstracts\2016\Tu1811.cgi | 0.002 | | Imaging | | | C:\inetpub\wwwroot\WebsiteHosting\SSAT\website\meetings\abstracts\2016\Tu1811.cgi | C:\inetpub\wwwroot\WebsiteHosting\SSAT\website\meetings\abstracts\2016\Tu1811.cgi | 0.002 | | Lab | | | | | <0.001 | | Nursing Unit (non-ICU) | | | | | <0.001 | | Nursing Unit (ICU) | | | C:\inetpub\wwwroot\WebsiteHosting\SSAT\website\meetings\abstracts\2016\Tu1811.cgi | C:\inetpub\wwwroot\WebsiteHosting\SSAT\website\meetings\abstracts\2016\Tu1811.cgi | 0.02 | | Pharmacy | | | | | 0.009 | | PT/OT/Speech | | | | C:\inetpub\wwwroot\WebsiteHosting\SSAT\website\meetings\abstracts\2016\Tu1811.cgi | 0.01 | | Surgical Services | | | | | <0.001 |
Wilcoxon rank-sum tests with p-values adjusted for the false discovery rate (FDR).
Back to 2016 Annual Meeting
|
