Cost-effectiveness analysis of hernioplasties before and after the implementation of the ACERTO project

Nascimento, José Eduardo de Aguilar; Salomão, Alberto Bicudo; Ribeiro, Mara Regina Rosa; Silva, Roberta Ferreira Da; Arruda, Wesley Santana Correa de

doi:10.1590/0100-6991e-20202438

Cited by 2 publications

(5 citation statements)

References 13 publications

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“…This review has explored the multifaceted components that define an ERP, especially the ERAS and ACERTO protocols, emphasizing the integration of evidence-based interventions across the preoperative, intraoperative, and postoperative phases. ERPs in digestive surgery can benefit not only the patient but also reduce costs in digestive surgery 2 , 45 . As the landscape of perioperative care continues to evolve, ongoing research and innovation will shape the future of ERPs.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Care in Digestive Surgery: The Eras and Acerto Protocols - Brazilian College of Digestive Surgery Position Paper

AGUILAR-NASCIMENTO,

RIBEIRO JUNIOR,

PORTARI-FILHO

et al. 2024

ABCD, arq. bras. cir. dig.

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Background: The concept introduced by enhanced recovery after surgery protocols modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period are highly important to ensure less postoperative complications, reduced length of hospital stay and decreased surgical costs. Aims: The aim of this position paper is to emphasize the most important points of a multimodal perioperative care protocol. Methods: A careful analysis of each recommendation of both ERAS and ACERTO protocols is presented, justifying its inclusion in the recommended multimodal care of digestive surgery patients. Results: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is highly important in digestive surgery and thus both preoperative and postoperative nutrition care are key to ensure less postoperative complications and to reduce the length of hospital stay. The concept of prehabilitation is another key element in ERPs. Management of crystalloid fluids in a perfect balance in vital. Fluid overload may delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fast for 2h before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance recovery of patients undergoing digestive procedures. Conclusions: This Brazilian College of Digestive Surgery position paper strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being. Background: The concept introduced by enhanced recovery after surgery protocols modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period are highly important to ensure less postoperative complications, reduced length of hospital stay and decreased surgical costs. Aims: The aim of this position paper is to emphasize the most important points of a multimodal perioperative care protocol. Methods: A careful analysis of each recommendation of both ERAS and ACERTO protocols is presented, justifying its inclusion in the recommended multimodal care of digestive surgery patients. Results: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is highly important in digestive surgery and thus both preoperative and postoperative nutrition care are key to ensure less postoperative complications and to reduce the length of hospital stay. The concept of prehabilitation is another key element in ERPs. Management of crystalloid fluids in a perfect balance in vital. Fluid overload may delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fast for 2h before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance recovery of patients undergoing digestive procedures. Conclusions: This Brazilian College of Digestive Surgery position paper strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.

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Section: Discussionmentioning

confidence: 99%

“…The integration of these modern prescriptions during the perioperative period is fundamental to ensure fewer postoperative complications, reduce the length of hospital stay, and decrease surgical costs 2 , 6 , 45 , 56 , 57 .…”

Section: Introductionmentioning

confidence: 99%

Perioperative Care in Digestive Surgery: The Eras and Acerto Protocols - Brazilian College of Digestive Surgery Position Paper

AGUILAR-NASCIMENTO,

RIBEIRO JUNIOR,

PORTARI-FILHO

et al. 2024

ABCD, arq. bras. cir. dig.

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“…We used a strategy of cost analysis using an indirect method that assessed daily total hospital charges as previously described 16 , 19 . The administrative core of the hospital was involved and produces data from the various units of costs, which ail the base of calculations.…”

Section: Discussionmentioning

confidence: 99%

“…The primary outcome of the study was the difference in hospital costs between the two periods. We used the costs accrual method according to NBCT 16.11 - Public Sector Cost Information System 5 , 16 . This method allows an indirect calculation of daily cost of the patients as follows.…”

Section: Methodsmentioning

confidence: 99%

“…In this context, the use of ERAS strategies of perioperative care has consistently shown that multimodal protocols can reduce costs and improve cost-effectiveness 12 , 18 , 20 . The reduction in hospital costs can be seen not only in major operations but also in hernioplasties in our hospital through the modification from traditional care to the ACERTO protocol 16 . However, until now, we did not have an analysis of costs in major procedures using the ACERTO protocol.…”

Section: Introductionmentioning

confidence: 97%

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Cost-Effectiveness of the Use of Acerto Protocol in Major Digestive Surgery

Aguilar-Nascimento

Bicudo-Salomão

Ribeiro

et al. 2022

ABCD, arq. bras. cir. dig.

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- BACKGROUND: Hospital costs in surgery constitute a burden for the health system in all over the world. Multimodal protocols such as the ACERTO project enhance postoperative recovery. OBJECTIVE: The aim of this study was to analyze the hospital costs in patients undergoing major digestive surgical procedures with or without the perioperative care strategies proposed by the ACERTO project. METHODS: Retrospective data from elective patients undergoing major digestive surgical procedures in a university hospital between January 2002 and December 2011 were collected. The investigation involved two phases: between January 2002 and December 2005, covering cases admitted before the implementation of the ACERTO protocol (pre-ACERTO period), and cases operated between January 2006 and December 2011, after implementation (ACERTO period). The primary outcome was the comparison of hospital costs between the two periods. As secondary end point, we compared length of stay (LOS), postoperative complications, surgical-site infection (SSI) rate, and mortality. RESULTS: We analyzed 381 patients (239 of the pre-ACERTO period and 142 of the ACERTO period) who underwent major procedures on the gastrointestinal tract. Patients operated after within the ACERTO protocol postoperative LOS had a median of 3 days shorter (p=0.001) when compared with pre-ACERTO period [median (IQR): 10 (12) days vs. 13 (12) days]. Mortality was similar between the two periods. Postoperative complications risk, however, was 29% greater (RR: 1.29; 95%CI 1.11-1.50) in the pre-ACERTO period (p=0.002). SSI risk was also greater in pre-ACERTO period (RR: 1.33; 95%CI 1.14-1.50). Costs (mean and SE) per patients were R$24,562.84 (1,349.33) before the implementation and R$19,912.81 (1,459.89) after the ACERTO protocol (p=0.02). CONCLUSION: The implementation of the ACERTO project in this University Hospital reduced the hospital costs in major digestive procedures. Moreover, the implementation of this modern perioperative care strategy also reduced postoperative complications, SSI risks, and LOS.

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Cost-effectiveness analysis of hernioplasties before and after the implementation of the ACERTO project

Cited by 2 publications

References 13 publications

Perioperative Care in Digestive Surgery: The Eras and Acerto Protocols - Brazilian College of Digestive Surgery Position Paper

Perioperative Care in Digestive Surgery: The Eras and Acerto Protocols - Brazilian College of Digestive Surgery Position Paper

Cost-Effectiveness of the Use of Acerto Protocol in Major Digestive Surgery

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