Study: Hospitals Can Save Money With Enhanced Recovery Program for Colorectal Surgery Patients

ERAS protocols are worth the investment, Johns Hopkins team says

The cost of implementing a new quality improvement program that helps colorectal surgery patients recover faster is more than offset by savings from their reduced lengths of stay at hospitals of any size, according to a study from Johns Hopkins Medical Institutions in Baltimore.

The patient-centric program incurs sizable up-front investments in patient educational materials, and dedicated time for front-line providers to develop and implement the pathway and to develop a framework for measuring their performance. However, such programs can produce significant savings for hospitals of various sizes with varying volumes of colorectal surgery, the researchers say. Their findings were published online in the Journal of the American College of Surgeons.

The authors analyzed the lengths of stay and costs documented in six published reports of Enhanced Recovery After Surgery (ERAS) programs that were implemented in U.S. hospitals for patients undergoing colorectal procedures between 2003 and 2015. Data from these reports were used to generate a financial model that reflected the net financial impact of implementing ERAS programs. The data included implementation costs, reductions in length of stay, and the per-day reductions in direct variable costs associated with shorter hospital stays, as well as annual surgical caseload. The study is believed to be one of the first to project costs and potential savings associated with the implementation of ERAS programs in the U.S.

ERAS programs create evidence-based protocols that promote the adoption of a standardized approach to implementation of evidence-based perioperative care. Key elements include preoperative counseling about expectations for the procedure and hospitalization among patients and their families, optimizing preoperative and postoperative nutrition, minimizing the use of narcotic pain management, and promoting early mobility after surgery.

The researchers used information from six ERAS program sites to compare the median length of stay with direct variable costs to the hospital, which include laboratory, pharmacy, radiology, and respiratory care materials and services before and after ERAS implementation. From these data, the investigators estimated that a one-day reduction in length of stay could save approximately $1,897 in direct variable costs, while a three-day reduction in hospital stay could save approximately $2,240.

Using their financial model, the researchers were able to adjust cost estimates by caseload. For hospitals with an estimated annual total of 100 colorectal procedures, the cost would be $117,875 for the implementation of ERAS in the first year and $107,875 in annual maintenance costs. The implementation of ERAS in a hospital performing 250 colorectal procedures per year would cost $325,000 in the first year and $216,300 in annual maintenance. A large colorectal surgical program performing 500 procedures per year would cost $552,783 initially and $356,944 annually thereafter.

These costs are more than offset by net savings, according to the researchers. At the Johns Hopkins Hospital, ERAS protocols reduced lengths of stay on average by 1.9 days (26%) and direct variable costs by $1,897 per patient. With an annual caseload of 500 patients, ERAS protocols yielded a total cost savings of $948,500. Subtracting the $552,783 cost of implementing the ERAS program, the net annual savings totaled $395,717.

A sensitivity analysis predicted cost savings in 20 of 27 scenarios (74%). Net costs were higher in the seven scenarios that were associated with one-day reductions in lengths of stay. Scenarios associated with reductions of three days in length of stay were associated with savings of $107,130 to $1,322,220. The Johns Hopkins Hospital scenario showed a net saving of $159,720 to $634,720, depending on the cost saving for daily length of stay.

“According to this model, ERAS is a beneficial program for any size hospital,” said lead author Elizabeth Wick, MD, FACS. “There is no excuse for saying ‘our hospital only does a few cases, so it’s not worth it for us to invest in these protocols.’ The benefit is there, even for a small surgery program.”

Source: American College of Surgeons; January 7, 2016.