Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery

Joliat, Gaëtan‐Romain; Labgaa, Ismaïl; Blanc, Catherine; Griesser, Anne-Claude; Schäfer, Markus; Demartines, Nicolas

doi:10.1007/s00268-016-3582-2

Cited by 61 publications

(52 citation statements)

References 48 publications

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“…These improvements in clinical outcome were associated with a non‐significant reduction in mean total costs of €7738 per patient in the ERAS group ( P = 0.273). The same group also reported similar cost benefits were found for an ERAS program for liver surgery . Real in‐hospital costs for 74 ERAS patients were compared with 100 pre‐ERAS patients.…”

Section: Gains From Implementation Of Erasmentioning

confidence: 65%

“…The same group also reported similar cost benefits were found for an ERAS program for liver surgery. 27 Real inhospital costs for 74 ERAS patients were compared with 100 pre- ERAS patients. The median length of stay was shorter for the ERAS group (8 vs 10 days, P = 0.006) as was the complication rate (49 vs 64%; P = 0.046).…”

Section: Gains From Implementation Of Erasmentioning

confidence: 99%

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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: 65%

Section: Gains From Implementation Of Erasmentioning

confidence: 99%

ERAS—Value based surgery

Ljungqvist

Thanh

Nelson

2017

Journal of Surgical Oncology

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“…Finally, although the benefits in outcomes of ERAS protocols have been translated in significant cost saving in colorectal surgery, from around $2,800 to $5,900 per patient, this has not been widely confirmed in liver surgery yet [4] . Although a recent retrospective cost-benefit analysis of ERAS in liver surgery from Switzerland found a total mean cost reduction of €3,080 per patient compared to traditional care, this difference did not reach statistical significance (P = 0.467) [104] . The main outcomes of ERAS protocols reported in the literature are summarized in Table 2.…”

Section: Outcomes Of Eras Protocols Compared With Traditional Carementioning

confidence: 90%

Enhanced recovery after surgery in liver surgery

Kumar¹,

Jha²,

Negi³

2018

MIS

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Enhanced recovery after surgery (ERAS) or fast-track surgery protocols, have been implemented across surgical fields with positive impact on outcomes. These protocols represent a standardized and evidence-based multimodal perioperative strategy founded on a series of measures aiming to attenuate the physical and psychological stress responses to surgical insults, and to potentiate the postoperative rehabilitation of patients. The successful adoption of ERAS protocols in various specialties enabled its gradual acceptance in the complex field of liver surgery. Even though many elements have been adapted especially from colorectal surgery, a few elements of ERAS protocol are unique to liver surgery. The goals of enhanced recovery can be achieved with efforts beginning at the first interaction on outpatient basis. Core elements of this multidisciplinary effort include pre-operative counseling, shortened preoperative fasting, no pre-anesthetic medication, targeted antimicrobial prophylaxis and early withdrawal, preventing and treating of postoperative nausea and vomiting, minimally invasive approaches, avoidance of postoperative nasogastric decompression, preventing hypothermia, optimal perioperative fluid management, selective use of abdominal drains, early urinary catheter removal, optimal pain control, early oral feeding and mobilization. The available evidence from recent randomized controlled studies and meta-analyses comparing ERAS programs with traditional care in liver surgery suggests that length of hospital stay is shortened without increasing morbidity, mortality or readmission rates.

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“…A team from the same hospital in Switzerland also reported savings for patients undergoing liver surgery. The saving was more moderate at €3,080 per patient but still important albeit not statistically significant (25). As yet unpublished data from a study by Jones et al demonstrated a cost saving of £864 per patient having introduced an ERAS programme for open liver resection surgery.…”

Section: Hepatobiliary Surgerymentioning

confidence: 93%