A. N. Khanijow1, L. E. Goss1, M. S. Morris1, J. A. Cannon1, G. D. Kennedy1, J. S. Richman1, D. I. Chu1 1University Of Alabama at Birmingham,Department Of Surgery, Division Of Gastrointestinal Surgery,Birmingham, Alabama, USA
Introduction: ERAS pathways are standardized perioperative care programs that improve postoperative surgical outcomes, including reduced length of stay and readmissions. As more US hospitals adopt ERAS programs, evaluating its impact on healthcare costs is increasingly important in order to determine the value of implementing ERAS protocols. The purpose of this study was to assess the cost of an ERAS program for colorectal surgery through a retrospective analysis comparing surgeries done before ERAS and with ERAS.
Methods: ERAS was implemented at a tertiary-care single-institution in January 2015. Variable cost data, the costs that vary with care decisions, were collected from the institution's financial department for the surgical inpatient stay for patients undergoing elective colorectal surgery from 2012-2014 (pre-ERAS) and 2015-2017 (ERAS). Costs were adjusted for inflation to 2017 US dollars using the Producer Price Index. Variable costs (overall and by categories) were compared using Wilcoxon tests between the two cohorts and with stratification by severity of illness (SOI) into minor, moderate, major, and extreme.
Results: Of 1,692 elective colorectal surgeries, pre-ERAS procedures (n=389) and ERAS procedures (n=1,303) had median total variable costs per surgery of $7,495.32 and $6,386.71, respectively; a difference of $1,108.61 (p<0.001). Additionally, comparing the average total variable costs between the two groups showed procedures with ERAS saved $128.51 (p<0.001). When comparing costs by categories, significantly (p<0.001) decreased median costs for ERAS surgeries were seen in the following: nursing ($670.29), surgery ($353.88), anesthesiology ($246.59), pharmacy ($75.31), and lab costs ($45.96). Mean variable costs by these categories followed a similar trend with significant cost savings per procedure in ERAS surgeries for the following: surgery ($487.49), anesthesiology ($238.59), nursing ($16.05), and lab costs ($7.19). Of note, mean variable pharmacy costs per surgery were significantly more expensive with the ERAS protocol ($342.17, p<0.001). Median variable costs stratified by SOI were consistent with the overall analysis, revealing significant savings in median total variable costs and in the same cost categories for the ERAS cohorts with mild and moderate SOIs, compared to the pre-ERAS cohort.
Conclusion: ERAS implementation at a large institution resulted in reduced median and mean variable costs associated with hospital stay, showing that ERAS implementation can have both clinical and financial benefits.