January 07, 2016
2 min read

Enhanced recovery program for colorectal surgery reduces length of stay, costs

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A financial model demonstrated that an Enhanced Recovery After Surgery program for colorectal surgery would reduce length of hospital stays and result in substantial direct cost savings for U.S. hospitals.

“Enhanced Recovery After Surgery (ERAS) programs are multidisciplinary, evidence-based protocols implemented in the perioperative period in order to provide uniform patient care and improve clinical outcomes,” the researchers wrote.

Elizabeth Wick

While prior studies have shown ERAS protocols reduce complications, hospital stays and costs, and improve patient experience, “ERAS programs require initial investments in materials, clinician time and personnel, and capital equipment, which can be difficult for surgeons to justify to their hospital leadership,” Elizabeth Wick, MD, FACS, a colorectal surgeon at The Johns Hopkins Hospital, and associate professor of surgery at Johns Hopkins School of Medicine, said in a press release.

Therefore, Wick and colleagues developed a financial model to help surgeons project the net financial impact of implementing an ERAS program for colorectal surgery at U.S. academic hospitals. Model estimates were based on published data and experience from the ERAS program for colorectal surgery at The Johns Hopkins Hospital. Key variables included costs of program implementation, reduction in length of stay, reduction of direct variable cost per day from reduced length of stay and annual number of eligible colorectal surgery patients.

“With the model described in this study, surgeons can plug in their case volumes and current length of stay and cost metrics and determine the potential cost-savings, based on published U.S. studies, they might expect at their hospital,” Wick said in the press release. “The model gives surgeons a framework for having a sophisticated discussion about how to initiate these types of programs with hospital administrators and what type of return on investment can be anticipated. Hopefully it can be used to promote collaboration between surgeons and hospital leadership to really improve the quality, value and patient experience.”

Using example scenarios, the model projected that the mean reduction in length of hospital stay ranged from 0.7 days (10.3%) to 2.7 days (39.1%), saving between $830 and $3,100 per day. Upfront costs in the first year were projected to be $117,875 for 100 patients per year, $325,000 for 250 patients per year and $552,783 for 500 patients per year. These costs dropped to $107,875, $216,300 and $356,944, respectively, in subsequent years.

In the 500 patients per year scenario, total first-year cost savings of the ERAS program were $948,500, corresponding to a net savings of $395,717. Moreover, the model predicted cost savings in 20 out of 27 scenarios.

“According to this model, ERAS is a beneficial program for any size hospital,” Wick said in the press release. “There is no excuse for saying ‘our hospital only does a few cases, so it’s not worth it for us to invest in these protocols.’ The benefit is there, even for a small surgery program.” – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.