Enhanced Recovery after Surgery for Colorectal Surgery: A Review of the Economic Implications

Abstract

Enhanced Recovery After Surgery (ERAS) programs are transdisciplinary, evidence-based perioperative protocols that aim to standardize best practices and increase the value of delivered healthcare. Quality improvement programs such as ERAS for colorectal surgery have been linked to a reduction in rates of hospital-acquired infections (HAIs) including surgical site infection as well as a reduction in overall length of stay. Importantly, to achieve these results, hospitals must commit to fostering transdisciplinary collaboration across surgery, anesthesiology, and nursing, as well as alignment between frontline providers and hospital executives. This requires upfront investment as well as ongoing resource allocation to sustain the program but given the magnitude of the potential impact of a successful ERAS program on multiple domains of quality and safety, the investment will easily reap ongoing rewards. The purpose of this manuscript is to outline implementation and sustainability costs of an ERAS program as well as discuss the potential cost savings related to the program to further inform hospitals considering adoption of this approach to care.

Statewide Prehabilitation Program and Episode Payment in Medicare Beneficiaries

“…16 This is perhaps best demonstrated through recent efforts to streamline post-surgical care using enhanced recovery protocols, which have been shown to decrease postoperative length of stay and complications. [17][18][19] Recent changes to Medicare reimbursement using the inpatient prospective payment system have created additional pressure on hospitals to decrease length of stay. Savings from the reduction in length of stay must be considered within the reduction in payments for the index hospitalization (not statistically significant) to hospitals by Medicare.…”

Selective decontamination of the digestive tract in colorectal surgery reduces anastomotic leakage and costs: a propensity score analysis

“…Operations were performed or supervised by an experienced, certified colorectal surgeon. All patients were treated according to enhanced recovery after surgery (ERAS) principles [ 10 ]. Clinical data were retrospectively obtained from our internal documentation system.…”

Optimizing Outcomes with Enhanced Recovery

“…However, there are many limitations when examining the mechanisms of impact of ERPs on cost using these traditional audit measures [70,91,92]. The true costs and systemic values need to be considered.…”