Abstract:Background
Enhanced recovery after surgery (ERAS) is attracting extensive attention and being widely applied to reduce postoperative stress and accelerate recovery. However, the economic benefits of ERAS are less clarified at the social level. We aimed to assess the economic impact of ERAS in hepatectomy from the perspectives of patients, hospitals and society, as well as identify the approach to create the economic benefits of ERAS.
Methods
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“…[3] For patients, tangible and intangible costs are associated with prolonged hospital LOS. [59] Prolonged hospital LOS can result in signi cant tangible costs, including lost wages and potential nancial strain.…”
Background
Prolonged hospital length of stay (LOS) after major surgery is associated with increased mortality rates, readmissions, and postoperative complications, adversely affecting functional recovery. To address this issue and optimize resource allocation, we conducted a retrospective cohort study focusing on elective upper gastrointestinal cancer surgeries.
Methods
Observational retrospective cohort study of all patients who underwent various upper gastrointestinal cancer procedures at a major tertiary hospital in 2021. Data were extracted from a prospective database. Pre-, intra-, and post-operative factors were collected. Patients were dichotomized into expected LOS and prolonged LOS.
Results
111 patients were analyzed. The average age was 64.0 years and 36.9% underwent a Whipple’s procedure. 23.4% of the patients had prolonged hospital LOS. Patients with longer hospital LOS had no neoadjuvant radiation therapy (84.6% vs 82.4%, p = 0.016), more readmission to the theatre (34.6% vs 7.1%, p = 0.001), more unplanned ICU admissions (15.4% vs 2.4%, p = 0.023), longer ICU admissions (76.9% vs 74.1%, p = 0.012), lower intra-op Hb (106.5 ± 17.9 vs 115.8 ± 17.0, p = 0.021), lower day 1 post-op Hb (100.1 ± 17.3 vs 111.7 ± 15.7, p = 0.002), lower 1st -week nadir Hb (89.3 ± 17.0 vs 104.9 ± 16.6, p < 0.001) and more post-op transfusion requirements (23.1% vs 5.9%, p = 0.019). Univariate analysis identified several significant predictors of prolonged hospital LOS, including unplanned ICU admission, readmission to theatre, lowest intra-op Hb, lowest day 1 post-op Hb and 1st week Hb nadir. Multivariate analysis adjusting for unplanned ICU admission (OR = 6.80, CI 1.03-45.00, p = 0.047) and readmission to theatre (OR 8.48, CI 2.40–30.00, p = 0.001) revealed that lower Hb levels (OR 0.95, CI 0.92–0.98, p = 0.002) were associated with prolonged hospital LOS.
Conclusion
Post-operative anemia, unplanned return to theatre and unplanned ICU admission are significant factors contributing to extended hospital stays. Addressing post-operative anemia may effectively reduce hospital LOS.
“…[3] For patients, tangible and intangible costs are associated with prolonged hospital LOS. [59] Prolonged hospital LOS can result in signi cant tangible costs, including lost wages and potential nancial strain.…”
Background
Prolonged hospital length of stay (LOS) after major surgery is associated with increased mortality rates, readmissions, and postoperative complications, adversely affecting functional recovery. To address this issue and optimize resource allocation, we conducted a retrospective cohort study focusing on elective upper gastrointestinal cancer surgeries.
Methods
Observational retrospective cohort study of all patients who underwent various upper gastrointestinal cancer procedures at a major tertiary hospital in 2021. Data were extracted from a prospective database. Pre-, intra-, and post-operative factors were collected. Patients were dichotomized into expected LOS and prolonged LOS.
Results
111 patients were analyzed. The average age was 64.0 years and 36.9% underwent a Whipple’s procedure. 23.4% of the patients had prolonged hospital LOS. Patients with longer hospital LOS had no neoadjuvant radiation therapy (84.6% vs 82.4%, p = 0.016), more readmission to the theatre (34.6% vs 7.1%, p = 0.001), more unplanned ICU admissions (15.4% vs 2.4%, p = 0.023), longer ICU admissions (76.9% vs 74.1%, p = 0.012), lower intra-op Hb (106.5 ± 17.9 vs 115.8 ± 17.0, p = 0.021), lower day 1 post-op Hb (100.1 ± 17.3 vs 111.7 ± 15.7, p = 0.002), lower 1st -week nadir Hb (89.3 ± 17.0 vs 104.9 ± 16.6, p < 0.001) and more post-op transfusion requirements (23.1% vs 5.9%, p = 0.019). Univariate analysis identified several significant predictors of prolonged hospital LOS, including unplanned ICU admission, readmission to theatre, lowest intra-op Hb, lowest day 1 post-op Hb and 1st week Hb nadir. Multivariate analysis adjusting for unplanned ICU admission (OR = 6.80, CI 1.03-45.00, p = 0.047) and readmission to theatre (OR 8.48, CI 2.40–30.00, p = 0.001) revealed that lower Hb levels (OR 0.95, CI 0.92–0.98, p = 0.002) were associated with prolonged hospital LOS.
Conclusion
Post-operative anemia, unplanned return to theatre and unplanned ICU admission are significant factors contributing to extended hospital stays. Addressing post-operative anemia may effectively reduce hospital LOS.
“…Ropivacaine is more expensive than bupivacaine, but no direct comparison of equivalent doses for intrathecal use has been performed; this expense could easily be offset by facilitating enhanced recovery after surgery principles. [ 28 29 ]…”
Background and Aims:
Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine.
Methods:
The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel–Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables.
Results:
Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine (P = 0.02). The duration of sensory block (P < 0.001) and motor block (P < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine (P = 0.003).
Conclusion:
Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine.
“…The ability to scale ERAS from one surgical area to others can be enticing for hospital administrators, particularly as ERAS programs contribute to operating margins; shorter length of stay and increased bed turnover can offset the upfront investment. 2 Figure 1 Potential cardiac ERAS care bundles. When implementing a new CS ERAS program, the number and variety of potential care bundles can be overwhelming.…”
Section: Starting An Enhanced Recovery After Surgery Programmentioning
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