Cost–benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy

Joliat, Gaëtan‐Romain; Labgaa, Ismaïl; Petermann, David; Hübner, Martin; Griesser, Anne-Claude; Demartines, Nicolas; Schäfer, Markus

doi:10.1002/bjs.9957

Cited by 95 publications

(85 citation statements)

References 30 publications

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“…The decreased costs in the case of ERAS protocol mostly result from the reduced LOS and the tendency of lower readmission rate. Similar conclusions were drawn by Joliat et al and Lemanu et al in colorectal surgery and pancreatic surgery [29, 30]. …”

Section: Discussionsupporting

confidence: 90%

Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis

et al. 2016

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Enhanced recovery after surgery (ERAS) protocol is well established in many surgical disciplines and leads to a decrease in the length of hospital stay and morbidity. Multimodal protocols have also been introduced to bariatric surgery. This review aims to evaluate the current literature on ERAS in obesity surgery and to conduct a meta-analysis of primary and secondary outcomes. MEDLINE, Embase, Scopus and Cochrane Library were searched for eligible studies. Key journals were hand-searched. We analysed data up to May 2016. Eligible studies had to contain four described ERAS protocol elements. The primary outcome was the length of hospital stay; the secondary outcomes included overall morbidity, specific complications, mortality, readmissions and costs. Random effect meta-analyses were undertaken. The initial search yielded 1151 articles. Thorough evaluation resulted in 11 papers, which were analysed. The meta-analysis of the length of stay presented a significant reduction standard mean difference (Std. MD) = −2.39 (−3.89, −0.89), p = 0.002. The analysis of overall morbidity, specific complications and Clavien-Dindo classification showed no significant variations among the study groups. ERAS protocol in bariatric surgery leads to the reduction of the length of hospital stay while maintaining no or low influence on morbidity.

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Section: Discussionsupporting

confidence: 90%

Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis

et al. 2016

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“…Table shows examples of hospital cost‐savings from this systematic review including several others described below. A cost‐benefit analysis of an ERAS program for pancreaticoduodenectomy was performed by Joliat et al The preoperative, intraoperative, and postoperative costs were collected for each patient in the pre‐ERAS and ERAS implementation cohorts. Median hospital stay was lower in the ERAS group (15 vs 19 days; P = 0.029) as was the complication rate (68 vs 82%; P = 0.046).…”

Section: Gains From Implementation Of Erasmentioning

confidence: 99%

ERAS—Value based surgery

Ljungqvist

Thanh

Nelson

2017

Journal of Surgical Oncology

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This paper reviews implementation of ERAS and its financial implications. Literature on clinical outcomes and financial implications were reviewed. Reports from many different surgery types shows that implementation of ERAS reduces complications and shortens hospital stay. These improvements have major impacts on reducing the cost of care even when costs for implementation, and investment in time for personnel and training is accounted for. The conclusion is that ERAS is an excellent example of value based surgery.

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“…As mentioned in the methods, an ERAS protocol for pancreas surgery was implemented in 2012 in our department [16]. Even though laparoscopy is not per se part of the pathway, minimally invasive surgery is more and more often used in the context of ERAS.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes after distal pancreatectomy: Laparotomy vs. laparoscopy - A single-center series

Joliat

Demartines

Halkic

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundLaparoscopic distal pancreatectomy was introduced 15 years ago, but it is still not widely used. The aim of the study was to compare the postoperative complications and length of stay between open and laparoscopic distal pancreatectomy.Materials and methodsA search of our institutional pancreas database was performed. All consecutive distal pancreatectomy patients from 2000 to 2015 were identified. Demographics, peri- and postoperative outcomes were reviewed. Postoperative complications were graded using Clavien classification. Standard statistical analyses were performed.ResultsOne hundred and five patients underwent distal pancreatectomy (45 women, 60 men, median age of 63 years). Seventy-nine cases were performed open and 26 by laparoscopy (conversion rate from laparoscopy to laparotomy: 7/26). Characteristics of both groups were similar. The tumor proportion was similar in both groups (56/79 and 23/26, p = 0.114). Overall complication rate was 41/79 (52%) in the open group and 9/26 (36%) in the laparoscopy group (p = 0.175). Two patients died during hospital stay in the open group compared to 0 in the laparoscopy group (p = 1). The fistula rates were comparable (17/79 and 5/26, p = 1). Median length of stay was shorter for the laparoscopy group (8 vs. 12 days, p < 0.001), as well as the median intermediate care stay (1 vs. 3 days, p = 0.004).ConclusionShort-term outcomes after open and laparoscopic distal pancreatectomy regarding postoperative complications and mortality were similar, but length of stay was significantly shorter for the laparoscopic approach. Hence, laparoscopic distal pancreatectomy should be offered to all suitable patients.

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Cost–benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy

Abstract: ERAS implementation for pancreaticoduodenectomy did not increase the costs in this cohort. Savings were noted in anaesthesia/operating room, medication and laboratory costs. Fewer patients in the ERAS group required an ICU stay.

Cited by 95 publications

References 30 publications

Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis

Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis

ERAS—Value based surgery

Short-term outcomes after distal pancreatectomy: Laparotomy vs. laparoscopy - A single-center series

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