Differential Index-Hospitalization Cost Center Impact of Enhanced Recovery After Surgery Program Implementation

Background The Enhanced Recovery After Surgery (ERAS) colorectal guideline has been implemented widely across Alberta. Our study examined the clinical and cost impacts of eras on colon cancer patients across the province.Methods We first used both summary statistics and multivariate regression methods to compare, before and after guideline implementation, clinical outcomes (length of stay, complications, readmissions) in consecutive elective colorectal patients 18 or more years of age and in colon cancer and non-cancer patients treated at the Peter Lougheed Centre and the Grey Nuns Hospital between February 2013 and December 2014. We then used the differences in clinical outcomes for colon cancer patients, together with the average cost per hospital day, to estimate cost impacts.Results The analysis considered 790 patients (398 cancer and 392 non-cancer patients). Mean guideline compliance increased to 60% in cancer patients and 57% in non-cancer patients after ERAS implementation from 37% overall before ERAS implementation. From pre- to post-ERAS, mean length of stay declined to 8.4 ± 5 days from 9.5 ± 7 days in cancer patients, and to 6.4 ± 4 days from 8.8 ± 5.5 days in non-cancer patients (p = 0.0012 and p = 0.0041 respectively). Complications declined significantly in the renal, hepatic, pancreatic, and gastrointestinal groups (difference in proportions: 13% in cancer patients; p < 0.05). No significant change in the risk of readmission was observed. The net cost savings attributable to ERAS implementation ranged from $1,096 to $2,771 per cancer patient and from $3,388 to $7,103 per non-cancer patient.Conclusions Implementation of eras not only resulted in clinical outcome improvements, but also had a significant beneficial impact on scarce health system resources. The effect for cancer patients was different from that for noncancer patients, representing an opportunity for further refinement and study.

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Reduction of costs with enhanced recovery after surgery (ERAS) program implementation in an institution of a developing country

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2018.03.023 ◽

2018 ◽

Vol 25 ◽

pp. 173

Author(s):

Eduardo Zarate ◽

Angela Navas ◽

Arnold Barrios ◽

Alvaro Sarmiento ◽

Jairo Betancourt ◽

...

Keyword(s):

Developing Country ◽

Program Implementation ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Reduction Of Costs

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Postoperative Opioid Use Before and After Enhanced Recovery After Surgery Program Implementation

Annals of Surgery ◽

10.1097/sla.0000000000003409 ◽

2019 ◽

Vol 270 (6) ◽

pp. e69-e71 ◽

Cited By ~ 2

Author(s):

Vincent X. Liu ◽

Abigail Eaton ◽

Derrick C. Lee ◽

Vivian M. Reyes ◽

Shirley S. Paulson ◽

...

Keyword(s):

Program Implementation ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Opioid Use ◽

Before And After

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Adoption of Enhanced Recovery after Surgery Protocols in Breast Reconstruction in Alberta Is High before a Formal Program Implementation

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000002249 ◽

2019 ◽

Vol 7 (5) ◽

pp. e2249

Author(s):

Jennifer N. Redwood ◽

Ashlee E. Matkin ◽

Claire F. Temple-Oberle

Keyword(s):

Breast Reconstruction ◽

Program Implementation ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Formal Program

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Application of Enhanced Recovery After Surgery in Perioperative Period of Tympanoplasty and Mastoidectomy

Ear Nose & Throat Journal ◽

10.1177/0145561320928222 ◽

2020 ◽

pp. 014556132092822

Author(s):

Jing-Qian Tan ◽

Yu-Bin Chen ◽

Wei-Hao Wang ◽

Shao-Li Zhou ◽

Qi-Lin Zhou ◽

...

Keyword(s):

Postoperative Complications ◽

Otitis Media ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Perioperative Period ◽

Comfort Level ◽

Chronic Suppurative Otitis Media ◽

Control Group ◽

Suppurative Otitis Media ◽

Hospitalization Cost

Introduction: Enhanced recovery after surgery (ERAS) protocols are a series of perioperative care to optimize preoperative preparation, prevent postoperative complications, minimize stress, and speedup recovery. Tympanoplasty and mastoidectomy are common surgical procedures for chronic suppurative otitis media. Objective: To compare the efficacy and safety between ERAS and conventional recovery after surgery in the perioperative period of chronic suppurative otitis media. Methods: From April 2018 to February 2019, a total of 84 patients scheduled for tympanoplasty and/or mastoidectomy due to chronic suppurative otitis media were involved and randomly divided into the ERAS group and the control group. The patients’ preoperative anxiety, postoperative pain, and comfort level were determined by comparing the results of Self-Rating Anxiety Scale (SAS), Visual Analog Scale (VAS) and General Comfort Questionnaire (GCQ). The postoperative complications, postoperative hospital stay, and hospitalization cost were calculated. Results: The ERAS group showed a lower SAS score (30 [28-31.5] vs 35 [30-43], P < .05], a higher GCQ score (88 [84-100] vs 83 [78.25-92.25], P < .05), and a lower VAS score (0 [0-0] vs 1 [0-2], P < .05] after surgery. No significant difference ( P > .05) was observed between the ERAS group and the control group in postoperative complications, postoperative hospitalization time, and hospitalization cost, respectively. Conclusion: Enhanced recovery after surgery can reduce pain and improve comfort in the perioperative period of chronic suppurative otitis media.

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Psychological influences on wound healing

Perspectives in Surgery ◽

10.33699/pis.2019.98.8.312-314 ◽

2019 ◽

Vol 98 (8) ◽

pp. 312-314

Keyword(s):

Wound Healing ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Wound Complications ◽

State Of Mind ◽

Life Threatening ◽

Psychological Influences ◽

Fear And Anxiety ◽

Care Costs

Surgical wound complications remain a major cause of morbidity; although usually not life threatening, they reduce the quality of life. They are also associated with excessive health care costs. Wound healing is affected by many factors – wound characteristics, infection, comorbidities and nutritional status of the patient. In addition, though, psychological stress and depression may decrease the inflammatory response required for bacterial clearance and so delay wound healing, as well. Although the patient´s state of mind can be influenced only to a certain extent, we should nevertheless stick to ERAS (Enhanced Recovery After Surgery) guidelines and try to diminish fear and anxiety by providing enough information preoperatively, pay due attention to postoperative analgesia and seek to provide an agreeable environment.

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