Impact of implementation of an enhanced recovery program in gynecologic surgery on healthcare costs

Abstract Background Enhanced recovery programs have been associated with improved outcomes following gynecologic surgery. There is limited data on the effect of enhanced recovery programs on healthcare costs or healthcare service utilization. Objectives To evaluate differences in hospital charges for women undergoing surgery for a suspected gynecologic cancer managed in an enhanced recovery program as compared with conventional perioperative care. Study Design We performed a retrospective cohort study of women undergoing open abdominal surgery for a suspected gynecologic cancer before and after implementation of an enhanced recovery after surgery [ERAS] program. Consecutive patients from May to October 2014 and from November 2014 to November 2015 comprised the conventional perioperative care [pre-ERAS] and enhanced recovery after surgery [ERAS] cohorts, respectively. Patients were excluded if they underwent surgery with a multidisciplinary surgical team or minimally invasive surgery. All technical and professional charges were ascertained for all healthcare services from the day of surgery until postoperative day 30. Charges for adjuvant treatment were excluded. Charges were classified according to the type of clinical service provided. The primary outcome was the difference in total hospital charges between the pre-ERAS and ERAS groups. Secondary outcomes were between group differences in hospital charges within clinical service categories. Results A total of 271 patients were included in the analysis with 58 and 213 patients in the pre-ERAS and ERAS cohort, respectively. A total of 70,177 technical charges and 6,775 professional charges were identified and classified. The median hospital charge for a patient decreased 15.6% in the pre-ERAS to ERAS groups [95% CI 0-39%; p=0.008]. Patients in the ERAS group also had lower charges for laboratory services [20%; 95% CI 0-39%; p=0.04], pharmacy services [30%; 95% CI 14-41%; p Conclusions Hospital charges and healthcare service utilization were lower for enhanced recovery patients compared with patients receiving conventional perioperative care following open surgery for a suspected gynecologic cancer. Enhanced recovery programs may be considered as high value in healthcare as they provide improved outcomes while lowering resource use.