Cost-analysis of Enhanced Recovery After Surgery (ERAS) program in gynecologic surgery

Pache, Basile; Joliat, Gaëtan‐Romain; Hübner, Martin; Grass, Fabian; Demartines, Nicolas; Mathevet, Patrice; Achtari, Chahin

doi:10.1016/j.ygyno.2019.06.004

Cited by 51 publications

(39 citation statements)

References 32 publications

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“…5 The benefits of these ERAS pathways have been demonstrated in several recent studies from a small number of specialized centers in both gynecologic and gynecologic oncology patients. [8][9][10] While there have been ERAS surveys conducted among national gynecologic oncology societies, [11][12][13] it is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice

Bhandoria

Bhandarkar

Ahuja

et al. 2020

International Journal of Gynecological Cancer

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IntroductionEnhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns.MethodsRequests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods.ResultsData from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 61%, Americas 53%, Asia 30%, and Africa 17%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding.ConclusionThis international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.

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Section: Introductionmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice

Bhandoria

Bhandarkar

Ahuja

et al. 2020

International Journal of Gynecological Cancer

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“…The present study investigated whether a low-pressure PRM would exert a similar impact to a moderate-pressure PRM on postoperative shoulder pain and height of pneumoperitoneum on chest X-ray in patients undergoing LS for non-malignant Laparoscopic surgery and minimally invasive techniques have been attractive for professionals dealing with gynecologic diseases as these procedures have been shown to reduce surgery-related trauma and postoperative pain, and shorten hospital stay [6]. The laparoscopic technique enhances the recovery process by decreasing perioperative stress and shortening the time required for ambulation and proper gastrointestinal functioning [7].…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic surgery and minimally invasive techniques have been attractive for professionals dealing with gynecologic diseases as these procedures have been shown to reduce surgery-related trauma and postoperative pain, and shorten hospital stay [ 6 ]. The laparoscopic technique enhances the recovery process by decreasing perioperative stress and shortening the time required for ambulation and proper gastrointestinal functioning [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients.

Yılmaz

Katılmış

Akça

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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A b s t r a c tIntroduction: The pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing post-laparoscopic shoulder pain (PLSP). However, the optimal lower pressure level for a PRM to reduce PLSP has not yet been investigated. Aim: To compare the efficacy of the low-pressure PRM with moderate-pressure PRM in preventing PLSP. Material and methods: Seventy-two ASA I-II patients who were scheduled for gynecologic LS for non-malignant conditions were enrolled in this study. Group 1 included patients who received the PRM at a maximum pressure of 30-40 cm H 2 O in a semi-Fowler position and group 2 included patients who received the PRM at a maximum pressure of 15 cm H 2 O in a semi-Fowler position. The primary outcome of the study was the difference in PLSP between the two groups. Results: There were no significant differences in PLSP and wound pain VAS scores between patients receiving the PRM at 30 cm H 2 O and 15 cm H 2 O during postoperative pain monitoring (p < 0.05). The groups were also similar with respect to ambulation time (p = 0.215), length of hospital stay (p = 0.556) and the height of the pneumoperitoneum measured on chest X-ray (p = 0.151). provides similar efficacy as the moderate-pressure PRM (30-40 cm H 2 O) in terms of PLSP, wound pain, height of pneumoperitoneum, time of ambulation and length of hospital stay. We suggest that lower maximal inspiratory pressure of 15 cm H 2 O might be preferred to avoid the potential complications of the PRM with higher pressures.

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“…A recent report from a European tertiary care center partially overcomes this limitation by describing in numeric terms the cost to provide care for patients after gynecologic surgery before and after the implementation of an ERAS program. 24 Finally, we recognize that one of the limitations of this study is the fact that the number of patients in the pre-ERAS cohort is disproportionately smaller than the post-ERAS cohort. This resulted from a preplanned strategy by our team to collect, before the implementation of the ERAS program, all parameters that were going to be measured after the ERAS program was initiated.…”

Section: Strengths and Weaknessesmentioning

confidence: 90%

Impact of implementation of an enhanced recovery program in gynecologic surgery on healthcare costs

Harrison

Guzman

et al. 2020

American Journal of Obstetrics and Gynecology

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BACKGROUND: Enhanced recovery programs have been associated with improved outcomes after gynecologic surgery. There are limited data on the effect of enhanced recovery programs on healthcare costs or healthcare service use. OBJECTIVE: The purpose of this study was to evaluate differences in hospital charges for women who undergo surgery for a suspected gynecologic cancer that is managed in an enhanced recovery program as compared with conventional perioperative care. STUDY DESIGN: We performed a retrospective cohort study of women who underwent open abdominal surgery for a suspected gynecologic cancer before and after the implementation of an enhanced recovery after surgery program. Consecutive patients from May to October 2014 and from November 2014 to November 2015 comprised the conventional perioperative care (before enhanced recovery after surgery) and enhanced recovery after surgery cohorts, respectively. Patients were excluded if they underwent surgery with a multidisciplinary surgical team or minimally invasive surgery. All technical and professional charges were ascertained for all healthcare services from the day of surgery until postoperative day 30. Charges for adjuvant treatment were excluded. Charges were classified according to the type of clinical service provided. The primary outcome was the difference in total hospital charges between the preeenhanced recovery after surgery and the enhanced recovery after surgery groups. Secondary outcomes were between group differences in hospital charges within clinical service categories. RESULTS: A total of 271 patients were included in the analysis (58 patients in the preeenhanced recovery after surgery and 213 patients in the enhanced recovery after surgery cohort). A total of 70,177 technical charges and 6775 professional charges were identified and classified. The median hospital charge for a patient decreased 15.6% in the enhanced recovery after surgery group compared with the preeenhanced recovery after surgery group (95% confidence interval, 5e24.5%; P¼.008). Patients in the enhanced recovery after surgery group also had lower charges for laboratory services (20% lower; 95% confidence interval, 0-39%; P¼.04), pharmacy services (30% lower; 95% confidence interval, 14-41%; P<.001), room and board (25% lower; 95% confidence interval, 20-47%; P¼.005), and material goods (64% lower; 95% confidence interval, 44-81%; P<.001). No differences in charges were observed for perioperative services, diagnostic procedures, emergency department care, transfusion-related services, interventional radiology procedures, physical/occupational therapy, outpatient care, or other services. CONCLUSION: Hospital charges and healthcare service use were lower for enhanced recovery patients compared with patients who received conventional perioperative care after open surgery for a suspected gynecologic cancer. Enhanced recovery programs may be considered to be high value in healthcare because they provide improved outcomes while lowering resource use.

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Cost-analysis of Enhanced Recovery After Surgery (ERAS) program in gynecologic surgery

Cited by 51 publications

References 32 publications

Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice

Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice

Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients.

Impact of implementation of an enhanced recovery program in gynecologic surgery on healthcare costs

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