Health economics in Enhanced Recovery After Surgery programs.
OBJECTIVE
The Enhanced Recovery After Surgery (ERAS) program aims to combine and coordinate evidence-based perioperative care interventions that support standardizing and optimizing surgical care. In conjunction with its clinical benefits, it has been suggested that ERAS reduces costs through shorter convalescence and reduced morbidity. Nevertheless, few studies have evaluated the cost-effectiveness of ERAS programs. The aim of this systematic review, therefore, is to evaluate the claims that ERAS is cost-effective and to characterize how these costs were reported and evaluated.


METHODS
The electronic databases, MEDLINE(®) and EMBASE™, were searched from inception to April 2014.


RESULTS
Seventeen studies met the inclusion criteria and were included for review. Enhanced Recovery After Surgery protocols in various abdominal surgeries have been investigated, including colorectal, bariatric, gynecological, gastric, pancreatic, esophageal, and vascular surgery. All studies reported cost savings associated with hastening recovery and reducing morbidity and complications. All studies included in this review focused primarily on in-hospital costs, with some attempting to account for readmission costs and follow-up services. In all but two studies, the breakdown of cost data for the individual studies was poorly detailed.


CONCLUSIONS
In conclusion, ERAS protocols appear to be both clinically efficacious and cost effective across a variety of surgical specialties in the short term. Nevertheless, studies reporting out-of-hospital cost data are lacking. Further research is required to determine how best to evaluate both medium- and long-term costs relating to ERAS pathways while taking quality of life data into account.
Department of Surgery, Middlemore Hospital, University of Auckland, Private Bag 23311, Otahuhu, Auckland, 1600, New Zealand.
Marinus D J
MD
Stowers
Daniel P
DP
Lemanu
Andrew G
AG
Hill
D003362:Cost-Benefit Analysis; D055317:Evidence-Based Practice; D013509:Gynecologic Surgical Procedures; D006801:Humans; D016577:Pancreaticoduodenectomy; D019990:Perioperative Care; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000601:surgery; D014656:Vascular Surgical Procedures