Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center

Stone, Alexander B.; Grant, Michael C.; Roda, Claro Pio; Hobson, Deborah B.; Pawlik, Timothy M.; Wu, Christopher L.; Wick, Elizabeth C.

doi:10.1016/j.jamcollsurg.2015.11.021

Cited by 131 publications

(85 citation statements)

References 15 publications

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“…In Switzerland, Roulin reported savings of €1651 (€1 = US$1.1214 at http://www.xe.com on June 14 2017) while introducing ERAS and at the same time moving to costlier minimally invasive surgery . Another recent cost analysis from the US showed that while the cost of implementation was high (US$550 000), the savings were even greater (US$950 000) resulting in savings of approximately US$400 000 . Lemanu et al performed a systematic review to assess cost effectiveness of enhanced recovery programs in colorectal surgery .…”

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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Section: Gains From Implementation Of Erasmentioning

confidence: 99%

ERAS—Value based surgery

Ljungqvist

Thanh

Nelson

2017

Journal of Surgical Oncology

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mentioning

confidence: 59%

“…To this end, it is even secondary whether the observed differences are statistically significant. Several studies showed the cost benefits of ERAS in different countries reinforcing the previous argument [1,2].At first glance, the MERCI equation seems attractive and simple to use. We agree that prediction with personal and tailored data before investment is of importance.…”

mentioning

confidence: 67%

MERCI for Improving Quality of Surgical Care at No Cost: Reply

2016

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We thank you for your interest and your comment on our article assessing the implementation costs of an Enhanced Recovery After Surgery (ERAS) program in liver surgery.Implementation of ERAS programs is similar to other types of projects in the world of business: you have to invest first, and return on investment goes along with the later success if any. For ERAS programs, the return on investment is achieved by improvements in quality of care (diminution of complications and reduction in length of stay) and systematization of management. As you mentioned, the present study illustrates well the benefits of such programs and could serve as prove to convince more hospital managers to implement ERAS programs.It is true that costs of care are largely varying as reimbursements are mainly depending on the respective health care systems. However, it is not the absolute costs per se that are important but the difference between the costs in a cohort of ERAS patients compared to a cohort of non-ERAS patients from a same institution. To this end, it is even secondary whether the observed differences are statistically significant. Several studies showed the cost benefits of ERAS in different countries reinforcing the previous argument [1,2].At first glance, the MERCI equation seems attractive and simple to use. We agree that prediction with personal and tailored data before investment is of importance. In this regard, the MERCI formula is a good suggestion as it may allow a rough guess on cost savings. However, some issues need be considered. The MERCI equation is not referenced and has presently not been externally validated precluding large-scale use. The expected decrease in the complication rate can often not reliably be estimated prior to implementation of an ERAS program. It is based on published data of the literature and often not originating from the same region or country. Even though the Clavien classification allows a standardized reporting of postoperative complications, it does not reference all complications in an individual patient. Currently, more holistic classifications such as the Comprehensive Classification Index could help to correct this issue [3]. Moreover, the MERCI equation does not take into account the durability of cost savings. Indeed, as described in our article, the financial gain is per patient. In consequence, the more patients are treated within an ERAS program, the more savings are done over time.

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“…Standardized quality improvement efforts such as Enhanced Recovery (ER) protocols with colorectal surgery have been reported to be associated with improved patient satisfaction, decreased length of hospital stay, reduced complication rate, and reduced costs [19,20]. These evidence-based pathways provide the opportunity to standardize any number of aspects of patient care.…”

Section: Discussionmentioning

confidence: 99%

“…as [19][20][21][22][23][24][25] % for open repairs [7,8]. Other reasons for unplanned 30-day readmission following VIHR are ileus or obstruction, bleeding, pulmonary issues, and venous thromboembolism (VTE) [1].…”

mentioning

confidence: 99%

Ventral and incisional hernia: the cost of comorbidities and complications

et al. 2016

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ASA Class ≥ 3, Wound Class > 1, open abdominal wound, and postoperative complications significantly increase costs. Although the hospital encounter represents the majority of the cost associated with VIHR, additional costs are incurred during the 90-day postoperative period. An appreciation of global costs is essential in developing alternative payment models for hernia in order to provide the greatest value in hernia care.

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Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center

Cited by 131 publications

References 15 publications

ERAS—Value based surgery

ERAS—Value based surgery

MERCI for Improving Quality of Surgical Care at No Cost: Reply

Ventral and incisional hernia: the cost of comorbidities and complications

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