Time-Driven Activity-Based Costing to Model Cost Utility of Enhanced Recovery after Surgery Pathways in Microvascular Breast Reconstruction

Mericli, Alexander F.; McHugh, Thomas M.; Kruse, Brittany; DeSnyder, Sarah M.; Rebello, Elizabeth

doi:10.1016/j.jamcollsurg.2020.01.035

Cited by 26 publications

(23 citation statements)

References 49 publications

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“…In a study by Mericli et al, the authors found that the cost is decreased by at least $19,336.75 if LOS was estimated by projecting that patients will spend the first two postoperative days in the ICU and the remainder of the hospitalization at the ward. 21,25 In addition, the study also demonstrated that ERAS protocols save $735.04 per case as well as one additional day of quality-adjusted life. 25 There are few limitations in our study.…”

Section: Discussionmentioning

confidence: 78%

Utility of ERAS Pathway in Nonabdominal-Based Microsurgical Breast Reconstruction: Efficacy in PAP Flap Reconstruction?

Cho

Garza

Teotia

et al. 2021

J Reconstr Microsurg

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Background Enhanced recovery after surgery (ERAS) protocols are effective in decreasing hospital length of stay and inpatient opioid consumption. Implementation of these protocols in abdominally based breast reconstruction has been successful. When a patient is a poor candidate for abdominally based flaps a popular secondary option is the profunda artery perforator (PAP) flap. We present our experience with implementation of our ERAS protocol in patients treated with PAP flaps for breast reconstruction. Methods Retrospective review of patients treated with autologous breast reconstruction using PAP flaps before and after ERAS implementation were performed. Patient characteristics, postoperative oral morphine equivalents (OMEs), and flap data were collected. Results A total of 87 patients were included in this study (58 patients in pre-ERAS and 29 patients in ERAS group). There was no statistical difference in patient age, comorbidities, smoking, and radiation between two groups. The ERAS group had statistically lower hospital length of stay (2.6 vs. 3.8 days), procedure time (315 vs. 433 minutes), postoperative day 0 (54.8 vs. 96.3), postoperative day 1 (29.9 vs. 57.7), and total opioid consumption (103.7 vs. 192.1). There was no statistical difference in average pain scores between two groups. Multivariate analysis revealed that procedure time significantly increased the amount of opioid consumption while ERAS implementation significantly reduced LOS and opioid consumption. Conclusion Use of an ERAS protocol in PAP flap breast reconstruction has not been previously studied. Our work shows that ERAS implementation in PAP flap breast reconstruction significantly reduces inpatient opioid use and length of hospital stay.

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Section: Discussionmentioning

confidence: 78%

Utility of ERAS Pathway in Nonabdominal-Based Microsurgical Breast Reconstruction: Efficacy in PAP Flap Reconstruction?

Cho

Garza

Teotia

et al. 2021

J Reconstr Microsurg

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“…27 Considering an indirect economic impact analysis, yet another study used data provided by the finance department to estimate the indirect gains obtained by the reduction of materials and medications consumed and the length of time spent by patients in intensive care units as the result of the adoption of ERP protocols for bariatric surgery. 28 One recently published study 29 applied the TDABC framework to evaluate the cost-effectiveness of microvascular breast surgeries. The use of the method allowed more detailed cost accounting and data accuracy of direct and indirect costs by enabling patient-specific resource consumption over the care pathway.…”

Section: The Cost and Economic Evaluation Process In Erp And Other Perioperative Surgical Pathway Redesign Implementationsmentioning

confidence: 99%

A Standardized Framework for Evaluating Surgical Enhanced Recovery Pathways: A Recommendations Statement from the TDABC in Health-care Consortium

Etges

Stefani

Vrochides

et al. 2021

JHEOR

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Background: Innovative methodologies to redesign care delivery are being applied to increase value in health care, including the creation of enhanced recovery pathways (ERPs) for surgical patients. However, there is a lack of standardized methods to evaluate ERP implementation costs. Objectives: This Recommendations Statement aims to introduce a standardized framework to guide the economic evaluation of ERP care-design initiatives, using the Time-Driven Activity-Based Costing (TDABC) methodology. Methods: We provide recommendations on using the proposed framework to support the decision-making processes that incorporate ERPs. Since ERPs are usually composed of activities distributed throughout the patient care pathway, the framework can demonstrate how the TDABC may be a valuable method to evaluate the incremental costs of protocol implementation. Our recommendations are based on the review of available literature and expert opinions of the members of the TDABC in Healthcare Consortium. Results: The ERP framework, composed of 11 steps, was created describing how the techniques and methods can be applied to evaluate the economic impact of an ERP and guide health-care leaders to optimize the decision-making process of incorporating ERPs into health-care settings. Finally, six recommendations are introduced to demonstrate that using the suggested framework could increase value in ERP care-design initiatives by reducing variability in care delivery, educating multidisciplinary teams about value in health, and increasing transparency when managing surgical pathways. Conclusions: Our proposed standardized framework can guide decisions and support measuring improvements in value achieved by incorporating the perioperative redesign protocols.

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“… 8 Initiatives for responsible resource stewardship, from time-driven activity-based costing to surgeon scorecards, can improve operational efficiency without compromising care quality. 9 Examples such as the Transforming Healthcare Resources to Increase Value and Efficiency Initiative led by ACS and Harvard Business School illustrate how surgeons can access unique levers to increase value in care delivery.…”

Section: Foundations For Value: From Measurement To Managementmentioning

confidence: 99%

“…Hospitals could reduce institutional demand and expand gateways to care by investing in ASCs, which could be further economized using resource management methods like activity-based costing and surgeon scorecards. 9 Additionally, surgery's history of rapid standardization (eg, the Enhanced Recovery after Surgery program) will help reduce variation in costs and outcomes for ASCs. To support home-based physical rehabilitation, payers may need to broaden durable medical equipment categories.…”

Section: Frontiers For Value: From Outbreaks To Outcomesmentioning

confidence: 99%

Charting a Roadmap for Value-based Surgery in the Post-pandemic Era

et al. 2020

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Time-Driven Activity-Based Costing to Model Cost Utility of Enhanced Recovery after Surgery Pathways in Microvascular Breast Reconstruction

Cited by 26 publications

References 49 publications

Utility of ERAS Pathway in Nonabdominal-Based Microsurgical Breast Reconstruction: Efficacy in PAP Flap Reconstruction?

Utility of ERAS Pathway in Nonabdominal-Based Microsurgical Breast Reconstruction: Efficacy in PAP Flap Reconstruction?

A Standardized Framework for Evaluating Surgical Enhanced Recovery Pathways: A Recommendations Statement from the TDABC in Health-care Consortium

Charting a Roadmap for Value-based Surgery in the Post-pandemic Era

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