Impact of an ERAS programme on clinical outcomes and institutional costs in elective laparoscopic and open colorectal resections

Abstract

Objectives: The aim of this study was to assess the cost-effectiveness of standardised ERAS colorectal programme. We have investigated the impact of colorectal ERAS programme on different dimensions of effectiveness, in order to compare relevant cost items across treatment groups. Methods: To determine the costs-effectiveness of the ERAS programme vs. traditional care for patients undergoing elective colorectal surgery we collected costs on: 1) Preoperative phase (i.e. counselling) 2) Direct cost of hospitalisation and re-hospitalisation (i.e. drugs, exams, length of stay (LOS)) in a prospective series of 76 patients undergoing elective colorectal resection following a standardised ERAS protocol in 2013-2014 (ERAS group) compared to 74 patients operated in the same institution before the introduction of ERAS methodology in 2010-11 (Traditional group). In both groups exclusion criteria were: age >80 years, ASA IV, TNM IV and inflammatory bowel disease. Functional recovery time, morbidity and mortality, LOS and readmission rate between groups were compared. Data (median [IQR 25-75] or mean±SD) were analyzed using chi-square, t-Test, and log-rank tests. Linear regression analysis was performed to identify factors associated with an increase in costs. Results: Time to functional recovery and LOS (4 [4-6] vs. 8 [7-9] days, p<0.001) were shorter in the ERAS group vs. controls. Morbidity, mortality, and 30-day readmissions did not significantly differ between groups. Total mean direct costswere significantly higher in the traditional group compared with the ERAS group (V7,664.93±4,018.15 vs.V5,350.19±1,560.78;p<0.001). Linear regression analysis showed that the average differences in cost between the two groups appear to be driven by LOS.Conclusion: Implementing an ERAS programme in elective colorectal surgery: 1) significantly reduced both time to functional recovery and LOS; 2) did not increase morbidity, mortality, and 30-day readmissions; 3) significantly decreased direct costs