Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada

Abstract

Background: Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. Methods:We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180-and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars.

Return on Investment in Endovascular Care: The Case of Endovascular Reperfusion Alberta

“…For example, the enhanced recovery after surgery intervention for colorectal, pancreas, cystectomy, liver, and gynecologic oncology procedures, had the lowest impact at 30 days, peaked at 90 days, and then decreased at 365 days, after the surgery. 21 Similarly, the EVT had the lowest impact at 90 days, peaked at 1 year and then decreased at 5 years. This follows the episodic nature of stroke such that survivors to one year do not have substantially different health care needs than age-matched controls.…”

Does Size Matter? Opioid Use after Laparoscopy for Apical Pelvic Organ Prolapse Using an 8 mm versus 10—12 mm Accessory Port

“…Sutures were tied without strangulation of tissue but ensured the tip of the surgeon's fifth digit could not pass the fascia. Perioperative care was as per the Enhanced Recovery After Surgery protocols at our institution (15,16). This includes preoperative administration of 1000mg acetaminophen and 400mg ibuprofen 1-hour prior to surgery, as well as scheduled acetaminophen and non-steroidal anti-inflammatory administration post-operatively unless allergies or contraindications exist.…”

Outcomes of Enhanced Recovery after Surgery (ERAS) in Gynecologic Oncology: A Review

“…Implementation of ERAS protocols incurs costs associated with training, audit, and additional nursing and allied health resources [ 14 , 26 ]. Improvements in length of stay and complications often account for the majority of cost savings seen following ERAS implementation for other surgical specialties [ 26 ].…”

“…Implementation of ERAS protocols incurs costs associated with training, audit, and additional nursing and allied health resources [ 14 , 26 ]. Improvements in length of stay and complications often account for the majority of cost savings seen following ERAS implementation for other surgical specialties [ 26 ]. Cost effectiveness was reported in 7 studies of ERAS in gynecologic oncology with statistically significant cost savings, with savings ranging from around 950 USD to over 8500 USD [ 11 , 14 , 18 , 27 , 28 , 29 , 30 ] (prices adjusted to 2018 USD).…”

“…There are significant differences in costs estimated from surgery due to the wide variety of surgery studied in this population, as well as differences in costs between public and private health care systems. Finally, a recent health economic analysis of multiple ERAS pathways, including gynecologic oncology from Alberta, Canada, showed a return on investment (ROI) ratio of 7.3 in favor of ERAS meaning that every 1 CAD invested in the program would bring 7.3 CAD in return, confirming that ERAS is a value-based surgery protocol [ 26 ].…”