Enhanced recovery after surgery (ERAS) programs are based on multidisciplinary collaboration and are designed to mitigate the surgical stress response and hasten convalescence. 1,2 ERAS implementation substantially reduces hospital length of stay (LOS), opioid use, and costs while maintaining stable readmission rates and pain scores. 3 Studies regarding ERAS have focused primarily on oncologic procedures in gynecologic and colorectal surgery. 4,5 Yet, variability continues between specific components of ERAS pathways across and within surgical specialties. Driver elements accounting for the heterogeneous impact of ERAS on perioperative outcomes in gynecologic surgery need to be determined, with most previously assessed protocols not including incisional infiltration with liposomal bupivacaine (LB).
Objective To compare perioperative costs and morbidity between open and robotic sacrocolpopexy after implementation of enhanced recovery after surgery (ERAS) pathway. Methods The present retrospective cohort study of patients undergoing open or robotic sacrocolpopexy (January 1, 2014, through November 30, 2017) used an ERAS protocol with liposomal bupivacaine infiltration of laparotomy incisions. Primary outcomes were costs associated with index surgery and hospitalization, determined with Medicare cost‐to‐charge ratios and reimbursement rates and adjusted for variables expected to impact costs. Secondary outcomes included narcotic use, length of stay (LOS), and complications from index hospitalization to postoperative day 30. Results For the total of 231 patients (open cohort, 90; robotic cohort, 141), the adjusted mean cost of robotic surgery was $3239 higher compared with open sacrocolpopexy (95% confidence interval [CI] $1331–$5147; P < 0.001). Rates were not significantly different for intraoperative complications (robotic, 4.3% [6/141]; open, 5.6% [5/90]; P = 0.754), 30‐day postoperative complications (robotic, 11.4% [16/141]; open, 16.7% [15/90]; P = 0.322), or readmissions (robotic, 5.7% [8/141]; open, 3.3% [3/90]; P = 0.535). The percentage of patients dismissed on postoperative day 1 was greater in the robotic group (89.4% [126/141] vs. 48.9% [44/90], P < 0.001). Conclusions Decreased LOS associated with ERAS provided significant cost savings with open sacrocolpopexy versus robotic sacrocolpopexy without adverse impacts on perioperative complications or readmissions.
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