Enhanced Recovery After Surgery can Improve Patient Outcomes and Reduce Hospital Cost of Gastrectomy for Cancer in the West: A Propensity-Score-Based Analysis

Abstract

Background Data on ERAS for gastrectomy are scarce, and the majority of the studies come from Eastern countries. Patients in the West are older and suffer from more advanced tumors that impair their clinical condition and often require neoadjuvant treatment. This retrospective study assessed the feasibility and safety of an Enhanced Recovery After Surgery (ERAS) protocol for gastrectomy in a Western center. Methods We conducted a single-center study of 351 patients operated for gastric cancer: 103, operated from January 2015 to December 2016, followed the standard pathway, while 248, operated from January 2017 to December 2019, followed the ERAS program. The primary outcomes considered were length of hospital stay (LOS) and direct costs. Secondary outcomes were 90-day morbidity and mortality, readmission rate, and compliance with ERAS items. A propensity score (PS) was built on confounding variables. Results Compliance with ERAS items after the program was ≥ 70%. Univariable analysis evidenced a 2-day median reduction in LOS and a median cost reduction of €826 per patient in the ERAS group. PS-based multivariable analysis confirmed a significant, 2-day decrease in median LOS and a €1097 saving after ERAS introduction. Ninety-day mortality decreased slightly in ERAS group, while complications and readmissions did not change significantly. When complications were included in the multivariable analysis, ERAS retained its significance, although the effects on LOS and cost were blunted to a median reduction of 1 day and €775, respectively. Conclusions ERAS for gastrectomy improved patients’ recovery and reduced hospital costs without changes in morbidity, mortality, or readmission.

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

“…Due to this, we considered our findings as appropriate to be compared though the total number of procedures in the two periods were uneven. A decrease in costs using ERAS protocol by comparing two periods as we used in this study has been reported as well, which is consistent with our findings 12 , 20 .…”

“…Various studies which compared costs with or without ERAS multimodal protocol showed the same with international currencies such as Euros, British Pounds, or Swiss Francs. 12 , 18 , 20 The overall results seem to agree that changing traditional to modern perioperative care may decrease costs and postoperative morbidity.…”

“…Hospital costs in surgery represent a burden for the health system all over the world 2 , 11 , 19 , 22 . 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 .…”

MRI T2WI High Signal Is a Risk Factor for Perioperative Complications in Patients with Cervical Spondylosis with Spinal Cord Compression: A Propensity Matching Score Analysis

“…The use of PSM (propensity score matching) analysis in our clinical study allowed for a good correction of selectivity bias, which was confirmed in many previous studies [ 18 – 21 ]. SPSS used version 22.0 (SPSS, Inc., Chicago, IL, USA), and P value < 0.05 was considered statistically significant.…”

Implementation of the ERAS program in gastric surgery: a nationwide survey in Italy

“…However, ERAS programs have also proven to be effective after open surgery with a reduction of postoperative infections [ 10 ] and acceleration of patients’ postoperative recovery [ 8 , 26 ]. The applications of ERAS programs, in patients treated with open surgery, can improve patients’ recovery and reduce hospital costs without increasing readmission or the need for postdischarge care [ 25 ].…”