Cost Saving Analysis of an Enhanced Recovery After Surgery (ERAS) Program for Elective Colorectal Surgery in an ERAS Qualified and Training Center.

Abstract

Background: To ascertain the costs of implementing an enhanced recovery after surgery (ERAS) protocol in elective colorectal surgery throughout all perioperative phases in an Italian ERAS Qualified and Training Center.

Methods: Consecutive patients who had undergone elective colorectal surgery in 2022, the first year of our facility being an ERAS Qualified Center (n 204; ERAS group), were compared to a control group (n 203; pre-ERAS group) that had undergone elective colorectal surgery in 2017, the last year before the internal ERAS implementation. The primary endpoint was the cost-effectiveness of the ERAS protocol as determined by evaluating perioperative costs. Secondary endpoints were postoperative clinical outcomes.

Results: In the ERAS group, fewer postoperative complications (p < 0.001), a shorter length of stay (LOS) (p < 0.001), and a decreased 30-day readmission rate (p 0.047) were reported. The mean cost saving for elective colorectal surgery in the ERAS setting was about €3676.73 per patient. The preoperative costs in the ERAS group were 45% higher than in the control group. The intraoperative phase showed a small but significant decrease in costs (-€324.04, SD 1683.81, and p 0.002). The postoperative phase also had a significant decrease in costs (-€3439.30, SD 6903.07, and p < 0.001), which was especially apparent in patients with severe complications.

Conclusions: Despite significantly increased costs in the preoperative phase, the ERAS protocol, when highly complied with, may lead to significantly decreased patient pathway costs due to a reduction of postoperative complications, a shorter LOS, and the more targeted use of medication and blood transfusions.