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Open Access 01-12-2024 | Liver Surgery | Research

From morbidity reduction to cost-effectiveness: Enhanced recovery after surgery (ERAS) society recommendations in minimal invasive liver surgery

Authors: Simon Moosburner, Paul M. Dahlke, Jens Neudecker, Karl H. Hillebrandt, Pia F. Koch, Sebastian Knitter, Kristina Ludwig, Can Kamali, Safak Gül-Klein, Nathanael Raschzok, Wenzel Schöning, Igor M. Sauer, Johann Pratschke, Felix Krenzien

Published in: Langenbeck's Archives of Surgery | Issue 1/2024

Abstract

Purpose

Minimal-invasive liver surgery (MILS) reduces surgical trauma and is associated with fewer postoperative complications. To amplify these benefits, perioperative multimodal concepts like Enhanced Recovery after Surgery (ERAS), can play a crucial role. We aimed to evaluate the cost-effectiveness for MILS in an ERAS program, considering the necessary additional workforce and associated expenses.

Methods

A prospective observational study comparing surgical approach in patients within an ERAS program compared to standard care from 2018—2022 at the Charité – Universitätsmedizin Berlin. Cost data were provided by the medical controlling office. ERAS items were applied according to the ERAS society recommendations.

Results

537 patients underwent liver surgery (46% laparoscopic, 26% robotic assisted, 28% open surgery) and 487 were managed by the ERAS protocol. Implementation of ERAS reduced overall postoperative complications in the MILS group (18% vs. 32%, p = 0.048). Complications greater than Clavien-Dindo grade II incurred the highest costs (€ 31,093) compared to minor (€ 17,510) and no complications (€13,893; p < 0.001). In the event of major complications, profit margins were reduced by a median of € 6,640.

Conclusions

Embracing the ERAS society recommendations in liver surgery leads to a significant reduction of complications. This outcome justifies the higher cost associated with a well-structured ERAS protocol, as it effectively offsets the expenses of complications.

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Title: From morbidity reduction to cost-effectiveness: Enhanced recovery after surgery (ERAS) society recommendations in minimal invasive liver surgery
Authors: Simon Moosburner
Paul M. Dahlke
Jens Neudecker
Karl H. Hillebrandt
Pia F. Koch
Sebastian Knitter
Kristina Ludwig
Can Kamali
Safak Gül-Klein
Nathanael Raschzok
Wenzel Schöning
Igor M. Sauer
Johann Pratschke
Felix Krenzien
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Liver Surgery
Liver Surgery
Liver Resection
Liver Resection
Published in: Langenbeck's Archives of Surgery / Issue 1/2024
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-024-03329-5

At a glance: The STEP trials

Springer Medicine

From morbidity reduction to cost-effectiveness: Enhanced recovery after surgery (ERAS) society recommendations in minimal invasive liver surgery

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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