An enhanced recovery after surgery program for video-assisted thoracoscopic surgery anatomical lung resections is cost-effective

Abstract

Background: Enhanced recovery after surgery (ERAS) programs have been reported to decrease complications and shorten hospital stays after lung resections, but their implementation requires time and financial investment with dedicated staff. The aim of this study was to evaluate the clinical and economic outcomes of video-assisted thoracoscopic surgery (VATS) anatomical pulmonary resections before and after implementation of an ERAS program. Methods: The first 50 consecutive patients undergoing VATS lobectomy or segmentectomy for malignancy after implementation of an ERAS program were compared with 50 consecutive patients treated before its introduction. The ERAS protocol included preoperative counseling, reduced preoperative fasting with concomitant carbohydrate loading, avoidance of premedication, standardized surgery, anesthesia and postoperative analgesia, early removal of chest tube, nutrition and mobilization. Length of stay, readmissions and cardio-pulmonary complications within 30 days were compared. Total costs were collected for each patient and a cost-minimization analysis integrating ERAS-specific costs was performed.Results: Both groups were similar in terms of demographics and surgical characteristics. The ERAS group had significantly shorter postoperative length of stay (median: 4 vs. 7 days, P<0.0001), decreased pulmonary complications (16% vs. 38%; P=0.01) and decreased overall post-operative complications (24% vs. 48%, P=0.03). One patient in each group was readmitted and there was no 30-day mortality. ERASspecific costs were calculated at €729 per patient including the clinical nurse and database costs. Average total hospitalization costs were significantly lower in ERAS group (€15,945 vs. €20,360, P<0.0001), mainly due to lower costs during the post-operative period (€7,449 vs. €11,454, P<0.0001) in comparison with the intra-operative period (€8,496 vs. €8,906, P=0.303). Cost-minimization analysis showed a mean saving in the ERAS group of €3,686 per patient.Conclusions: An ERAS program for VATS anatomical lung resection is cost-effective and is associated with a lower complication rate and a shorter postoperative hospitalization.

Cost-analysis of Enhanced Recovery After Surgery (ERAS) program in gynecologic surgery

“…Similar to our findings, Gerardi et al observed a reduction of hospital costs by $5'410 per patient [20]. Furthermore, the results of the present study are in line with findings in colorectal, hepato-biliary, thoracic or earnose-throat (ENT) surgeries [7,14,[21][22][23]. In these areas ERAS pathways proved to be cost-beneficial, partly due to decreased complications.…”

Short-and long-term outcomes of video-assisted thoracoscopic lobectomy in elderly patients with non-small-cell lung cancer

“…In this study, the older patients had poor pulmonary function performance as compared to their counterparts, which indicated that the postoperative risk complications were higher with older patients (≥ 70 years of age) as compared to younger patients (≤ 70 years of age). The ERAS model was rst proposed by the Danish surgeon Kehlet in 1997 [39][40][41]. It refers to the comprehensive use of a series of optimization measures supported by evidence-based medicine during the perioperative period, including multidisciplinary collaboration of surgery, anesthesia, nursing, and nutrition, to optimize the clinical pathway for perioperative management, in order to reduce the perioperative stress response (i.e., physiological and psychological traumatic stress) and postoperative complications in surgical patients with the aim of achieving the best health status and rapid recovery with minimal cost.…”

“…It refers to the comprehensive use of a series of optimization measures supported by evidence-based medicine during the perioperative period, including multidisciplinary collaboration of surgery, anesthesia, nursing, and nutrition, to optimize the clinical pathway for perioperative management, in order to reduce the perioperative stress response (i.e., physiological and psychological traumatic stress) and postoperative complications in surgical patients with the aim of achieving the best health status and rapid recovery with minimal cost. Since the ERAS model was successfully applied for the rst time in gastrointestinal surgery, this concept has now been adopted in neurosurgery, thoracic surgery, and other surgical elds [39][40][41]. Studies have shown that under the ERAS protocol, it is possible to effectively reduce surgical trauma and postoperative stress response, shorten the length of hospitalization, and promote patient recovery in the perioperative period of VATS lobectomy [39][40][41].…”

“…Since the ERAS model was successfully applied for the rst time in gastrointestinal surgery, this concept has now been adopted in neurosurgery, thoracic surgery, and other surgical elds [39][40][41]. Studies have shown that under the ERAS protocol, it is possible to effectively reduce surgical trauma and postoperative stress response, shorten the length of hospitalization, and promote patient recovery in the perioperative period of VATS lobectomy [39][40][41]. The results of our study revealed that postoperative complications and severe complications in the elderly group were similar to that of the nonelderly group.…”

“…Excised lymph nodes consisted of the intra-pulmonary, pulmonary hilar, and mediastinal lymph nodes, with the latter comprising mediastinal lymph nodes at stations 4L and 5-9 in the left mediastinum and at stations 2R, 4R, and 7-9 in the right mediastinum [38]. Perioperative management was carried out using the Enhanced Recovery After Surgery (ERAS) principles [39][40][41].…”