Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post‐implementation expenditures

Abstract

Enhanced Recovery After Surgery programmes were first conceived to optimise perioperative patient care and have been delivered by surgical specialities in the UK for over a decade. Although their safety and acceptability have been ratified in many surgical fields including gynaecology and colorectal surgery, the cost effectiveness of its implementation in benign vaginal surgery remains unclear. In this case-control study, the perioperative expenditure for 45 women undergoing vaginal hysterectomy at a North London teaching hospital after implementation of an enhanced recovery pathway was compared with 45 matched controls prior to implementation. Frequency of catheter use (84.4% vs. 95.6%) and median length of stay (23.5 vs. 42.9 h) were significantly lower following implementation of pathway (both p < 0.05). Although enhanced recovery patients were more likely to attend the accident and emergency department for minor symptoms following discharge (15.6% vs. 0%, p < 0.05), the inpatient readmission rate (6.7% vs. 0.0%, p > 0.05) was similar in both groups. Establishing the programme incurred additional expenditures including delivering a patient-orientated gynaecology 'school' and employing a specialist enhanced recovery nurse, but despite these, we demonstrated a saving of 15.2% (or £164.86) per patient. The cost efficiency savings, coupled with increased satisfaction and no rise in morbidity, offers a very attractive means of managing women undergoing vaginal hysterectomy. We believe that our data can be reproduced in other centres and recommend that the pathway be used routinely in women undergoing these procedures.

Health economics in Enhanced Recovery After Surgery programs

“…In this review, studies investigating the cost as either a primary or secondary outcome have been conducted in Europe, [7][8][9][10][11][12] Asia, [13][14][15][16][17][18] North America, 2,19 USA, 20 and Australasia. 1,21 Six of the 17 studies were systematic reviews.…”

“…8,9,13,18,20,21 Thus, no study achieved the minimum score to be considered ''high quality''. Three studies in gynecology scored 11 of a possible 19.…”

“…8,9 Even so, very few studies made any attempt to look at cost-transfer from the hospital to the community. This is an important consideration given that any cost reduction shown in the included studies could be tempered by transference of costs to community health services, which could potentially result from a shortened LOS.…”

“…Relph et al reported on similar cost data in their study of 100 patients (50 ERAS and 50 control patients). 9 Median length of stay was more than halved (22.0 hr vs 45.5 hr, respectively; P \ 0.01) with a cost savings of £106.30 per patient.…”

Vaginal hysterectomy and training

“…These advantages have been maximized when associated with enhanced recovery programmes. Patients after vaginal hysterectomy can be discharged home in as little as 8 h and hospitals can save up to £300 per patient with no increase in complications or reduction in patient satisfaction [3].…”