Enhanced recovery protocols could reduce colorectal surgery costs substantially

More than $2,000 savings per case is possible
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Hospitals could save hundreds of thousands of dollars a year by streamlining just one of its service lines: Colorectal surgery.

A study that will be published soon in the Journal of the American College of Surgeons (ACS) has concluded that the key to saving money is the use of enhanced recovery after surgery (ERAS) programs, according to a research announcement.

ERAS programs include a variety of standardized protocols, including preoperative counseling, postoperative nutritional guidelines, an emphasis on mobility right after surgery, and less reliance on the use of painkillers. Such protocols gained traction in Europe over the past 15 years, but are also experiencing growing momentum in the U.S. That is propelled in part by the fact that nearly 1 in 7 patients of major surgery wind up being readmitted within 30 days of discharge.

Researchers examined the benefits of six ERAS programs deployed at U.S. hospitals between 2003 and 2015. The data shows that reducing the average length of stay by one day could save a hospital $1,897 in direct variable costs, while a more optimistic three-day reduction in a hospital stay could save about $2,240.

However, the costs of implementing an ERAS program are pretty steep: A hospital that performs 250 colorectal surgeries a year would have to spend $325,000 in the first year and $216,300 a year thereafter for maintenance. For a large program performing more than 500 procedures a year, the cost would be $552,783 in the first year and $356,944 in annual maintenance after that.

But it could be worth the investment. A large program performing 500 procedures a year would save more than $395,000 using such a protocol.

"ERAS programs require initial investments in materials, clinician time and personnel, and capital equipment, which can be difficult for surgeons to justify to their hospital leadership. With the model described in this study, surgeons can plug in their case volumes and current length of stay and cost metrics and determine the potential cost-savings, based on published U.S. studies, they might expect at their hospital," said Elizabeth Wick, M.D., a colorectal surgeon at Johns Hopkins and the study's lead author, in a statement issued by the ACS.

To learn more:
- read the ACS statement

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