Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy.
BACKGROUND
Enhanced recovery after surgery (ERAS) programmes have been shown to decrease complications and hospital stay. The cost-effectiveness of such programmes has been demonstrated for colorectal surgery. This study aimed to assess the economic outcomes of a standard ERAS programme for pancreaticoduodenectomy.


METHODS
ERAS for pancreaticoduodenectomy was implemented in October 2012. All consecutive patients who underwent pancreaticoduodenectomy until October 2014 were recorded. This group was compared in terms of costs with a cohort of consecutive patients who underwent pancreaticoduodenectomy between January 2010 and October 2012, before ERAS implementation. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration. A bootstrap independent t test was used for comparison. ERAS-specific costs were integrated into the model.


RESULTS
The groups were well matched in terms of demographic and surgical details. The overall complication rate was 68 per cent (50 of 74 patients) and 82 per cent (71 of 87 patients) in the ERAS and pre-ERAS groups respectively (P = 0·046). Median hospital stay was lower in the ERAS group (15 versus 19 days; P = 0·029). ERAS-specific costs were €922 per patient. Mean total costs were €56 083 per patient in the ERAS group and €63 821 per patient in the pre-ERAS group (P = 0·273). The mean intensive care unit (ICU) and intermediate care costs were €9139 and €13 793 per patient for the ERAS and pre-ERAS groups respectively (P = 0·151).


CONCLUSIONS
ERAS implementation for pancreaticoduodenectomy did not increase the costs in this cohort. Savings were noted in anaesthesia/operating room, medication and laboratory costs. Fewer patients in the ERAS group required an ICU stay.
Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.
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GR
Joliat
Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.
I
I
Labgaa
Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.
D
D
Petermann
Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.
M
M
Hübner
Medical Directorate, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.
A-C
AC
Griesser
Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.
N
N
Demartines
Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.
M
M
Schäfer
D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000191:economics*; D011182:Postoperative Care / Q000191:economics*; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function