17 - Freie Mitteilung
15. Mai 2019, 13:30 - 15:00, Bellavista 2, 6. OG
Cost-benefit analysis of an enhanced recovery program for gastrectomy
V. Luzuy-Guarnero1, C. Gronnier2, S. Figuereido1, S. Mantziari1, M. Schäfer1, N. Demartines1, P. Allemann1, Presenter: V. Luzuy-Guarnero1 (1Lausanne, 2Bordeaux/FR)
Enhanced recovery program (ERP) are nowadays widely used in surgery. They have been shown to decrease postoperative complications and length of hospital stay. In recent years, research on the financial impact of these protocols demonstrated cost reduction in colorectal, liver and pancreatic surgery. The present study aimed to assess the cost-effectiveness of ERP for both elective and emergency gastric surgery.
An ERP, based on the ERAS society guidelines for gastric surgery, has been implemented since June 2014 in our tertiary center. A prospective series of consecutive patients operated from June 2014 to December 2017 (ERAS group, n= 53), was compared to a control group (n=63) who underwent laparoscopic or open gastric surgery from January 2010 to Mai 2014 without ERP. Primary outcome was the cost-effectiveness analyses including preoperative, intraoperative and postoperative detailed costs. Secondary endpoints were the overall morbidity and length of stay. A subgroup analysis assessed the costs according to the comprehensive complication Index (CCI).
Both groups were comparable regarding demographic details. Overall complication rates in ERAS and control group (66% vs 64%, p=0.3) and length of stay (18 days vs 24 days, p=0.251) were similar. Mean overall costs per patient in the ERAS and control group were €36’881 and €55’178, but the difference was not statistically significant (p=0.371). Lower costs were found for intensive or intermediate care (-€7643), medication (-€1121), laboratory (-€1508) and blood transfusion (-€908). In patients with few or no complications (CCI < 20), the mean costs were lower in the ERAS group (€27’701 vs €31’455, p=0.04).
ERAS protocol are most cost-effective for gastric surgery in patients with no or few complications. The accruing costs for treating complications are so high, that the beneficial cost-effective effects of ERAS protocols are waived.