title: [Multimodal rehabilitation program in elective colorectal surgery: Impact on hospital costs].
abstract: BACKGROUND
  Multimodal rehabilitation (MMRH) programs in surgery have proven to be beneficial in functional recovery of patients. The aim of this study is to evaluate the impact of a MMRH program on hospital costs.
  
  
  METHODS
  A comparative study of 2 consecutive cohorts of patients undergoing elective colorectal surgery has been designed. In the first cohort, we analyzed 134 patients that received conventional perioperative care (control group). The second cohort included 231 patients treated with a multimodal rehabilitation protocol (fast-track group). Compliance with the protocol and functional recovery after fast-track surgery were analyzed. We compared postoperative complications, length of stay and readmission rates in both groups. The cost analysis was performed according to the system «full-costing».
  
  
  RESULTS
  There were no differences in clinical features, type of surgical excision and surgical approach. No differences in overall morbidity and mortality rates were found. The mean length of hospital stay was 3 days shorter in the fast-track group. There were no differences in the 30-day readmission rates. The total cost per patient was significantly lower in the fast-track group (fast-track: 8.107 ± 4.117 euros vs. control: 9.019 ± 4.667 Euros; P=.02). The main factor contributing to the cost reduction was a decrease in hospitalization unit costs.
  
  
  CONCLUSIONS
  The application of a multimodal rehabilitation protocol after elective colorectal surgery decreases not only the length of hospital stay but also the hospitalization costs without increasing postoperative morbidity or the percentage of readmissions.
authors.affiliation: Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario del Mar, Barcelona, España.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Salvans
authors.forename: M José
authors.initials: MJ
authors.lastname: Gil-Egea
authors.forename: Miguel
authors.initials: M
authors.lastname: Pera
authors.forename: Leyre
authors.initials: L
authors.lastname: Lorente
authors.forename: Francesc
authors.initials: F
authors.lastname: Cots
authors.forename: Marta
authors.initials: M
authors.lastname: Pascual
authors.forename: Sandra
authors.initials: S
authors.lastname: Alonso
authors.forename: Ricard
authors.initials: R
authors.lastname: Courtier
authors.forename: Luis
authors.initials: L
authors.lastname: Grande
mesh_terms: D000368:Aged; D003108:Colonic Diseases / Q000191:economics* / Q000534:rehabilitation* / Q000601:surgery; D003131:Combined Modality Therapy / Q000191:economics; D017558:Elective Surgical Procedures / Q000191:economics* / Q000534:rehabilitation*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012002:Rectal Diseases / Q000191:economics* / Q000534:rehabilitation* / Q000601:surgery
keywords: Cirugía colorrectal; Clinical pathway; Colorectal surgery; Costes; Costs; Fast-track; Multimodal rehabilitation; Rehabilitación multimodal; Vía clínica