Significant Cost Savings From Enhanced Recovery Pathway for Colorectal Surgery

A new study has shown that an Enhanced Recovery After Surgery (ERAS) pathway for colorectal surgery can help to reduce complications from health services utilization and significantly reduce total costs.

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ERAS programs are evidence-based, multimodal care pathways that aim to streamline clinical practice and reduce variability in care. Studies have shown that ERAS pathways can lead to fewer complications and help patients undergoing major surgery to recover sooner. 

At Alberta Health Services in Canada, a providence-wide, fully integrated health system, administrators implemented an ERAS pathway for colorectal surgeries consistent with ERAS Society guidelines. In a study published in the Canadian Journal of Surgery, researchers led by Nguyen X Thanh, MD, PhD, Institute of Health Economics (Edmonton, Canada), conducted an economic evaluation of the initial implementation phase of the ERAS between June 3, 2013, and March 31, 2015. 

Researchers assessed how the ERAS pathway affected patient length of stay, readmissions, emergency department visits, and general practitioner or specialist visits within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. A decision analytic modeling technique was used to estimate net health care costs and savings as well as the return on investment associated with implementation of the ERAS pathway. 

In total, 1295 post-ERAS patients and 331 pre-ERAS patients had colorectal surgery during the study period and were included in the final analysis. Overall, the results in both groups were very similar, with no significant differences in mortality, number of comorbidities, number of procedures, proportion of open surgeries, or amount of intraoperative blood loss. However, post-ERAS patients had lower rates of malignant neoplasms of the rectum (12.28% vs 16.92%) but higher rates of benign neoplasms of the colon, rectum, anus, and anal canal (8.42% vs 4.53%); slightly fewer comorbidities (mean, 2.86 vs 3.25) and procedures (mean, 2.01 vs 2.20); lower rates of open surgeries (35.75% vs 46.22%); and less intraoperative blood loss (mean, 190.4 mL vs 216.1 mL).

Further, implementation of ERAS pathways reduced health service utilization on all measures, although the only significant difference was in length of stay, with patients staying an average of 1.5 days less when treated after ERAS implementation. These reductions resulted in a net cost savings of ~$2,290,000, or $1768 per patient. The probability of the program being cost-effective was 73%-83%, and the return on investment was 3.8, meaning that every $1 invested in ERAS would bring in a return of $3.80.

Thus, the authors concluded that the initial phase of the ERAS implementation program for colorectal surgery in Alberta reduced costs. “Alberta Health Services provided a large health system that embraced rapid implementation of ERAS driven by the Strategic Clinical Networks. Alignment of system leadership and executive support of the frontline efforts required by the ERAS implementation program helped stimulate rapid uptake and interest across the province,” authors of the study wrote.

These savings could be more substantial were ERAS to be spread to other surgical specialties and sites, the authors noted.—Sean McGuire 

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Thanh NX, Chuck AW, Wasylak T, et al. An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta. Can J Surg. 2016;59(6):6716.