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World Journal of Surgery
Published in: World Journal of Surgery 10/2016

01-10-2016 | Original Scientific Report

Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery

Authors: Gaëtan-Romain Joliat, Ismaïl Labgaa, Martin Hübner, Catherine Blanc, Anne-Claude Griesser, Markus Schäfer, Nicolas Demartines

Published in: World Journal of Surgery | Issue 10/2016

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Abstract

Background

Enhanced recovery after surgery (ERAS) programs have been shown to ease the postoperative recovery and improve clinical outcomes for various surgery types. ERAS cost-effectiveness was demonstrated for colorectal surgery but not for liver surgery. The present study aim was to analyze the implementation costs and benefits of a specific ERAS program in liver surgery.

Methods

A dedicated ERAS protocol for liver surgery was implemented in our department in July 2013. The subsequent year all consecutive patients undergoing liver surgery were treated according to this protocol (ERAS group). They were compared in terms of real in-hospital costs with a patient series before ERAS implementation (pre-ERAS group). Mean costs per patient were compared with a bootstrap T test. A cost-minimization analysis was performed.

Results

Seventy-four ERAS patients were compared with 100 pre-ERAS patients. There were no significant pre- and intraoperative differences between the two groups, except for the laparoscopy number (n = 18 ERAS, n = 9 pre-ERAS, p = 0.010). Overall postoperative complications were observed in 36 (49 %) and 64 patients (64 %) in the ERAS and pre-ERAS groups, respectively (p = 0.046). The median length of stay was significantly shorter for the ERAS group (8 vs. 10 days, p = 0.006). The total mean costs per patient were €38,726 and €42,356 for ERAS and pre-ERAS (p = 0.467). The cost-minimization analysis showed a total mean cost reduction of €3080 per patient after ERAS implementation.

Conclusions

ERAS implementation for liver surgery induced a non-significant decrease in cost compared to standard care. Significant decreased complication rate and hospital stay were observed in the ERAS group.
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Metadata
Title
Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery
Authors
Gaëtan-Romain Joliat
Ismaïl Labgaa
Martin Hübner
Catherine Blanc
Anne-Claude Griesser
Markus Schäfer
Nicolas Demartines
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 10/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3582-2

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