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Background:
In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not onl...
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Citations
... The implementation of Enhanced Recovery After Surgery (ERAS) principles in colorectal cancer surgery has led to faster patient recovery, improved surgical outcomes, and reduced healthcare costs [1][2][3][4]. Rather than using specific interventions, it consists of a multimodal approach before, during, and after surgery aimed at reducing the surgical stress response and maintaining physiological functions [5]. ...
Background
The implementation of Enhanced Recovery After Surgery (ERAS) protocols has resulted in improved postoperative outcomes in colorectal cancer surgery. The evidence regarding feasibility and impact on outcomes in surgery for inflammatory bowel disease (IBD) is limited.
Methods
We performed a retrospective observational cohort study, comparing patient trajectories before and after implementing an IBD-specific ERAS protocol at Zealand University Hospital. We assessed the occurrence of serious postoperative complications of Clavien-Dindo grade 3 or higher as our primary outcome, with postoperative length of stay in days and rate of readmissions as secondary outcomes, using χ ² , Mann–Whitney test, and odds ratios adjusted for sex and age.
Results
From 2017 to 2023, 394 patients were operated on for IBD and included in our study. In the ERAS cohort, 39/250 patients experienced a postoperative complication of Clavien-Dindo grade 3 or higher compared to 27/144 patients in the non-ERAS cohort (15.6% vs. 18.8%, p = 0.420) with an adjusted odds ratio of 0.73 (95% CI 0.42–1.28). There was a significantly shorter postoperative length of stay (median 4 vs. 6 days, p < 0.001) in the ERAS cohort compared to the non-ERAS cohort. Readmission rates remained similar (22.4% vs. 16.0%, p = 0.125).
Conclusions
ERAS in IBD surgery was associated with faster patient recovery, but without an impact on the occurrence of serious postoperative complications and rate of readmissions.
... ERAS (Enhanced Recovery After Surgery) protocol has been introduced as standard of care in elective major abdominal surgery [1]. The economic effect of this protocol has been deeply investigated particularly in the field of elective colorectal surgery in which ERAS implementation has been associated with shorter length of stay (LOS) and reduction of postoperative complications rate [2][3][4]. ...
... In this series no significant differences in morbidity and readmissions rate between the 2 groups were observed. These findings are consistent with previous reports regarding surgical complications in implementing ERAS pathway [1][2][3][4]. On the other hand, the rate of complication might be explained in part considering baseline comorbidities of the patients treated, and in part it might be related to the partial number of items of the ERAS pathway achieved [1,20]. ...
Introduction
ERAS (Enhanced Recovery After Surgery) protocol is now proposed as the standard of care in elective major abdominal surgery. Implementation of the ERAS protocol in emergency setting has been proposed but his economic impact has not been investigated. Aim of this study was to evaluate the cost saving of implementing ERAS in abdominal emergency surgery in a single institution.
Methods
A group of 80 consecutive patients treated by ERAS protocol for gastrointestinal emergency surgery in 2021 was compared with an analogue group of 75 consecutive patients treated by the same surgery the year before implementation of ERAS protocol. Adhesion to postoperative items, length of stay, morbidity and mortality were recorded. Cost saving analysis was performed.
Results
50% Adhesion to postoperative items was reached on day 2 in the ERAS group in mean. Laparoscopic approach was 40 vs 12% in ERAS and control group respectively (p ,002). Length of stay was shorter in ERAS group by 3 days (9 vs 12 days p ,002). Morbidity and mortality rate were similar in both groups. The ERAS group had a mean cost saving of 1022,78 € per patient.
Conclusions
ERAS protocol implementation in the abdominal emergency setting is cost effective resulting in a significant shorter length of stay and cost saving per patient.
... For example, in the United Kingdom, the Enhanced Recovery Partnership Programme (ERPP) was introduced in 2009 by national agencies to support the implementation of ERAS programs for various surgery types, resulting in approximately 24,000 patients already recorded in the ERPP database in 2012 [5]. In Alberta, Canada, a fully integrated healthcare system named Alberta Health Services introduced a demonstration project implementing the colorectal ERAS guidelines and included more than 75% of all colorectal surgeries in the province up to 2015 [58]. In addition, ERAS adoption is rapidly gaining momentum in academic institutions and societies across Asia. ...
This review discusses the challenges of implementing enhanced recovery after surgery (ERAS) programs in South Korea. ERAS is a patient-centered perioperative care approach that aims to improve postoperative recovery by minimizing surgical stress and complications. While ERAS has demonstrated significant benefits, its successful implementation faces various barriers such as a lack of manpower and policy support, poor communication and collaboration among perioperative members, resistance to shifting away from outdated practices, and patient-specific risk factors. This review emphasizes the importance of understanding these factors to tailor effective strategies for successful ERAS implementation in South Korea’s unique healthcare setting. In this review, we aim to shed light on the current status of ERAS in South Korea and identify key barriers. We hope to encourage Korean anesthesiologists to take a leading role in adopting the ERAS program as the standard for perioperative care. Ultimately, our goal is to improve the surgical outcomes of patients using this proactive approach.
... Reducing hospital LOS is undoubtedly beneficial, offering gains in patient satisfaction, cost-effectiveness, and reduced risk of hospital-acquired infections. 35,36 Previous research has cited reductions in LOS by up to 3 days within ERAS cohorts. 15,19,34,[37][38][39] Our study similarly found a positive trend in reduced hospital stays, noting a decrease in LOS by 1 day. ...
Background
Enhanced recovery after surgery (ERAS) protocols have demonstrated efficacy following microvascular breast reconstruction. This study assesses the impact of an ERAS protocol following microvascular breast reconstruction at a high-volume center.
Methods
The ERAS protocol introduced preoperative counseling, multimodal analgesia, early diet resumption, and early mobilization to our microvascular breast reconstruction procedures. Data, including length of stay, body mass index, inpatient narcotic use, outpatient narcotic prescriptions, inpatient pain scores, and complications, were prospectively collected for all patients undergoing microvascular breast reconstruction between April 2019 and July 2021. Traditional pathway patients who underwent reconstruction immediately before ERAS implementation were retrospectively reviewed as controls.
Results
The study included 200 patients, 99 in traditional versus 101 in ERAS. Groups were similar in body mass index, age (median age: traditional, 54.0 versus ERAS, 50.0) and bilateral reconstruction rates (59.6% versus 61.4%). ERAS patients had significantly shorter lengths of stay, with 96.0% being discharged by postoperative day (POD) 3, and 88.9% of the traditional cohort were discharged on POD 4 ( P < 0.0001). Inpatient milligram morphine equivalents (MMEs) were smaller by 54.3% in the ERAS cohort (median MME: 154.2 versus 70.4, P < 0.0001). Additionally, ERAS patients were prescribed significantly fewer narcotics upon discharge (median MME: 337.5 versus 150.0, P < 0.0001). ERAS had a lower pain average on POD 0–3; however, this finding was not statistically significant.
Conclusion
Implementing an ERAS protocol at a high-volume microvascular breast reconstruction center reduced length of stay and postoperative narcotic usage, without increasing pain or perioperative complications.
... The ERAS protocol has repeatedly proven to reduce postoperative morbidity for non-surgical complications and length of stay (LOS) along with faster patient recovery [4][5][6]. Furthermore, superior patient satisfaction [7] and cost reduction were observed, despite additional expenses needed for protocol implementation [8,9]. Although ERAS programs have become broadly accepted and are expanding into a growing number of surgical fields [10,11], it is not fully understood, which parts of the bundle of measures contribute most to the improved outcome [12]. ...
Purpose
Enhanced recovery after surgery (ERAS) protocols have shown beneficial outcomes in the last 20 years. Nevertheless, simultaneously implemented technical improvements such as minimally invasive access or modified anesthesia care may play a crucial role in optimizing patient outcome. The aim of the study was to investigate the effect of ERAS implementation in a highly specialized colorectal center.
Methods
This is a propensity score matched single-center study comparing the short-term outcomes of patients undergoing elective colorectal surgery in a society-indepedent ERAS program from January 2021 to August 2022 to standard perioperative care from January 2019 to December 2020.
Results
Four hundred fifty-six patients were included in the propensity score matched analysis with 228 patients per group (ERAS vs. standard care). Minimally invasive access was used in 80.2% vs. 77.6% (p = 0.88), and there were 16.6% vs. 18.8% (p = 0.92) rectal procedures in the ERAS and standard care group, respectively. Major complications occurred in 10.1% vs. 11.4% (p = 0.65) and anastomotic leakage demanding operative revision in 2.2% vs. 2.6% (p = 0.68) in the ERAS and standard care group, respectively. ERAS lead to a lower number of non-surgical complications compared to standard care (57 vs. 79; p = 0.02). Mean length of stay (LOS) and mean costs per case were lower in ERAS compared to standard care (9.2 ± 5.6 days vs. 12.7 ± 7.4 days, p < 0.01; costs 33,727 ± 15,883 USD vs. 40,309 ± 29,738 USD, p < 0.01).
Conclusion
The implementation of an ERAS protocol may lead to a reduction of LOS, costs, and a lower number of non-surgical complications even in a highly specialized colorectal unit using modern surgical and anesthetic care. (ClinialTrials.gov number NCT05773248)
... With the potency of reducing patients' total costs, ERAS may become the appropriate solution to Indonesia's Universal Healthcare Coverage System, which demands optimum outcomes by utilizing limited resources and prioritizes cost-effectiveness as proven in a study in Alberta by Nguyen XT et al. who concluded that implementing the ERAS protocol in colorectal surgery could save 73%-83% (USD 1768) per patient. 23 Therefore, It is vital to see its cost-effectiveness in Indonesia and scalability to other facilities for broader implementation. ...
Introduction
Successful colorectal surgery is determined based on postoperative mortality and morbidity rates, complication rates, and cost-effectiveness. One of the methods to obtain an excellent postoperative outcome is the Enhanced Recovery After Surgery (ERAS) protocol. This study aims to see the effects of implementing an ERAS protocol in colorectal surgery patients.
Methods
Eighty-four patients who underwent elective colorectal surgery at National Tertiary-level Hospital were included between January 2021 and July 2022. Patients were then placed into ERAS (42) and control groups (42) according to the criteria. The Patients in the ERAS group underwent a customized 18-component ERAS protocol and were assessed for adherence. Postoperatively, both groups were monitored for up to 30 days and assessed for complications and readmission. We then analyzed the length of stay and total patient costs in both groups.
Results
The length of stay in the ERAS group was shorter than the control group (median [interquartile range/IQR]) 6[5-7] vs. 13[11-19], P <0.001), with a lower total cost of (USD 1,875 [1,234 – 3,722] vs. USD 3,063 [2,251 – 4,907], P <0.001). Patients in the ERAS group had a lower incidence of complications, 10% vs. 21%, and readmission 5% vs. 10%, within 30 days after discharge than patients in the control group; however, the differences were not statistically significant. The adherence to the ERAS protocol within the ERAS group was 97%.
Conclusion
Implementing the ERAS protocol in colorectal patients reduces the length of stay and total costs.
... The enhanced recovery after surgery (ERAS) protocol is a modern, multistage pathway of perioperative management aimed at improving quality of treatment [1, 2], accelerating the recovery process [3], and reducing the costs associated with the treatment itself [4,5]. Many studies have shown that the ERAS protocol is a valuable tool in caring for surgical patients [6]. ...
... 25 In addition to the clinical and system improvements noted earlier, a costeffectiveness economic evaluation demonstrated that health system savings amounted to more than 2 million dollars after factoring project implementation costs and a net savings of $1768/patient CAD. [26][27][28] The ERAS initiative was the signature project that enabled the launch of the benefits realization approach at AHS. The benefits realization approach enables innovation teams to demonstrate to health care funders and decision makers that their proposed solution has the potential to make the organization (or broader health system) measurably better and that the investment required for their proposed solution is likely to be worth it in relation to the value of the improvement that they expect to create. ...
Design, implementation, and evaluation of effective multicomponent interventions typically take decades before value is realized even when value can be measured. Value-based health care, an approach to improving patient and health system outcomes, is a way of organizing health systems to transform outcomes and achieve the highest quality of care and the best possible outcomes with the lowest cost. We describe 2 case studies of value-based health care optimized through a learning health system framework that includes Strategic Clinical Networks. Both cases demonstrate the acceleration of evidence to practice through scientific, financial, structural administrative supports and partnerships. Clinical practice interventions in both cases, one in perioperative services and the other in neonatal intensive care, were implemented across multiple hospital sites. The practical application of using an innovation pipeline as a structural process is described and applied to these cases. A value for money improvement calculator using a benefits realization approach is presented as a mechanism/tool for attributing value to improvement initiatives that takes advantage of available system data, customizing and making the data usable for frontline managers and decision makers. Health care leaders will find value in the descriptions and practical information provided.
... Previously it has been reported that ERAS considerably decreased main LOS, resulting in cost savings for health care. In terms of return on investment, each dollar invested in ERAS would yield $3.80 [7]. This conclusion is consistent with the findings reported by Stowers and colleagues [8] and Lee and colleagues [9]. ...
Keywords: Colorectal cancer surgery; ERAS protocol; Post-operative complications 1. Abstract 1.1. Introduction: The patient experiences post-operative complications after colorectal surgery. To reduce these complications, the ERAS protocol was developed. The current study assesses the impact of ERAS on the post-operative complications after colorec-tal surgery. 1.2. Method: The patients who were planned for elective colorec-tal surgery between February 2017 and January 2022 were recruited for the current study at Hayatabad Medical Complex, Peshawar, Pakistan. Each patient was informed about the ERAS protocol, and informed consent was obtained from each patient. The patients were divided into the non-ERAS group and the ERAS group. The data was analyzed using SPSS v25. 1.3. Results: In the ERAS group, there was a significant decrease in the CDC grades (P>0.0001). In addition, there was a significant reduction in the post-operative complications (p=0.015), except wound infection. The ERAS group's re-admission (p=0.001) and re-operation (p=0.013) rate within thirty days was significantly reduced. Moreover, the length of stay was significantly reduced in the ERAS group 1.4. Conclusion: The current study emphasizes the advantages of ERAS in colorectal surgery. The ERAS group had a considerably lower risk of post-operative complications, including CDC grading , surgical complications, re-admission, and re-operation within thirty days. 2. Introduction Patients with Major colorectal surgery often needs extensive post-operative rehabilitation due to severe endocrine, metabolic, neurological, and pulmonary function changes. After major elec-tive open colorectal surgery was performed under routine periop-erative care, the reported complication rate ranged from 15-20% to 45-48% [1]. This is not unexpected given that many standard therapies have been proved to be inadequate, if not detrimental, to patients. Return of bowel function is a key factor in post-operative recovery for patients who do not have complications. This is influenced by several perioperative factors such as preoperative fasting and bowel preparation, analgesic and anesthetic techniques, the magnitude and complications of the surgery, fluid overload, and the patient's co-morbidities [2]. ERAS programs are intended to reduce the stress response associated with surgery. Clinically, ERAS regimens result in improved physical performance, as measured by treadmill exercise, pulmonary function, and body composition, as measured by lean body mass [3]. The combination of many of these factors appears to have a positive synergistic effect on post-operative outcomes following colorectal surgery when compared to each individual parameter alone [4]. The ERAS program may be considered expensive in developing countries like Pakistan, with limited health resources. However, it decreases the post-operative complications, which directly affect the hospital stay and medication given to the patient. [5]. Therefore, the current study was conducted to assess the impact of ERAS on post-operative complications.
... The timing could not be better; a large backlog of patients is waiting for surgery because of the pandemic, and the economic pressure on societies world-wide is at a high because of the global political situation and COVID-19. ERAS is one of the most cost-effective (if not the most) way to improve outcomes 19 , reduce suffering for patients and potentially also save lives 20 . The tools and the knowledge are here. ...
