title: Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center.
abstract: BACKGROUND
  Despite positive results from several international Enhanced Recovery After Surgery (ERAS) protocols, the United States has been slow to adopt ERAS protocols, in part due to concern regarding the expenses of such a program. We sought to evaluate the potential annual net cost savings of implementing a US-based ERAS program.
  
  
  METHODS
  Using data from existing publications and experience with an ERAS program, a model of net financial costs was developed for surgical groups of escalating numbers of annual cases. Our example scenario provided a financial analysis of the implementation of an ERAS program at a United States academic institution based on data from the ERAS Program for Colorectal Surgery at The Johns Hopkins Hospital.
  
  
  RESULTS
  Based on available data from the United States, ERAS programs lead to reductions in lengths of hospital stay that range from 0.7 to 2.7 days and substantial direct cost savings. Using example data from a quaternary hospital, the considerable cost of $552,783 associated with implementation of an ERAS program was offset by even greater savings in the first year of nearly $948,500, yielding a net savings of $395,717. Sensitivity analysis across several caseload and direct cost scenarios yielded similar savings in 20 of the 27 projections.
  
  
  CONCLUSIONS
  Enhanced Recovery After Surgery protocols have repeatedly led to reduction in length of hospital stay and improved surgical outcomes. A financial model, based on published data and experience, projects that investment in an ERAS program can also lead to net financial savings for US hospitals.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Stone
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Grant
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Claro
authors.initials: C
authors.lastname: Pio Roda
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hobson
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pawlik
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wu
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: ewick1@jhmi.edu.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D017046:Cost Savings / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D018803:Models, Economic; D019990:Perioperative Care / Q000191:economics* / Q000379:methods; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control; D014481:United States