Cost minimization analysis of laparoscopic surgery for colorectal cancer within the enhanced recovery after surgery (ERAS) protocol: a single-centre, case-matched study.

Abstract

IntroductionThe goal of modern medical treatment is to provide high quality medical care in a cost-effective environment.AimTo assess the cost-effectiveness of laparoscopic colorectal surgery combined with the enhanced recovery after surgery protocol (ERP) in Poland.Material and methodsWe designed a single-centre, case-matched study. Economic and clinical data were collected in 3 groups of patients (33 patients in each group): group 1 – patients undergoing laparoscopy with ERP; group 2 – laparoscopy without ERP; group 3 – open resection without ERP. An independent administrative officer, not involved in the treatment process, matched patients for age, sex and type of resection. Primary outcome was cost analysis. It was carried out incorporating institutional costs: hospital bed stay, anaesthesia, surgical procedure and equipment, drugs and complications. Secondary outcomes were length of stay (LOS), readmission and complication rate.ResultsCost of laparoscopic procedure alone was significantly more expensive than open resection. However, implementation of the ERAS protocol reduced additional costs. Total cost per patient in group 1 was significantly lower than in groups 2 and 3 (EUR 1826 vs. EUR 2355.3 vs. EUR 2459.5, p < 0.0001). Median LOS was 3, 6 and 9 days in groups 1, 2 and 3 respectively (p < 0.001). Postoperative complications were noted in 5 (15.2%), 6 (18.2%) and 13 (39.4%) patients in groups 1, 2, 3 respectively (p = 0.0435).ConclusionsIn a low medical care expenditure country, minimally invasive surgery combined with ERP can be a safe and a cost-effective alternative to open surgery with traditional perioperative care.

Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A prospective randomized controlled trial

“…The readmission rate (<30 days) was similar in ERAS and CS groups, which indicated that the scientific discharge criteria in ERAS programs would not increase the readmission rate. The results of RCT were consistent with the research of ERAS protocol in laparoscopic colorectal surgery by Pędziwiatr et al …”

“…As the morbidity rate of overall complications decreased in ERAS group after implementing the ERAS programs, which proved that ERAS programs can safely reduce surgical stress and accelerate patient recovery. We can see that compared with CS group, the patients in ERAS group had low peak of WBCs and ALT,also had higher number of ALB in postoperative days, which Pędziwiatr et al [20][21][22][23] The advantages of ERAS concept manifest in more adequate preoperative preparation before surgery. The detailed preoperative education can reduce patient anxiety through communication.…”

Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: A prospective, randomized single center study

“…Enhanced recovery after surgery (ERAS) protocols have become increasingly popular over the past decade. These pathways have proven to significantly reduce postoperative length of stay and costs after colorectal surgery . Fast‐track colorectal surgery has been comprehensively discussed, but few reports have examined the fast‐track program for VATS lobectomy …”

“…These pathways have proven to significantly reduce postoperative length of stay and costs after colorectal surgery. [1][2][3] Fasttrack colorectal surgery has been comprehensively discussed, [4][5][6] but few reports have examined the fast-track program for VATS lobectomy. 7,8 Thoracic epidural analgesia (TEA) is generally considered the gold standard of analgesia after thoracotomy.…”

A technical note on low cost rat laparoscopy an initial experience

“…Their acceptance and consistency of results are accompanied by the development of instruments that enable and facilitate an increasing number of procedures [1][2][3] . However, the cost of this technology 12 creates several limitations that hamper the development of experimental models, especially in small animals.…”