Cost-benefit analysis and short-term outcomes after implementing an ERAS protocol for colorectal surgery: a propensity score-matched analysis.

Autor: Ruiz Torres I; Department of Anaesthesia, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain., Serrano AB; Department of Anaesthesia, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain., Juez LD; Department of General Surgery and Digestive System, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ctra. Colmenar, Km 9,1., 28034, Madrid, Spain. luz.juez@gmail.com., Ballestero Pérez A; Department of General Surgery and Digestive System, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ctra. Colmenar, Km 9,1., 28034, Madrid, Spain., Ocaña Jiménez J; Department of General Surgery and Digestive System, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ctra. Colmenar, Km 9,1., 28034, Madrid, Spain., Die Trill J; Department of General Surgery and Digestive System, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ctra. Colmenar, Km 9,1., 28034, Madrid, Spain.; Universidad de Alcalá (UAH), Madrid, Spain., Fernandez Cebrian JM; Department of General Surgery and Digestive System, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ctra. Colmenar, Km 9,1., 28034, Madrid, Spain.; Universidad de Alcalá (UAH), Madrid, Spain., García Pérez JC; Department of General Surgery and Digestive System, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Ctra. Colmenar, Km 9,1., 28034, Madrid, Spain.; Universidad de Alcalá (UAH), Madrid, Spain.
Jazyk: angličtina
Zdroj: Techniques in coloproctology [Tech Coloproctol] 2024 Sep 23; Vol. 28 (1), pp. 130. Date of Electronic Publication: 2024 Sep 23.
DOI: 10.1007/s10151-024-02997-1
Abstrakt: Background: Enhanced Recovery After Surgery (ERAS) has become increasingly popular in the post-operative management of abdominal surgery. Published data suggest that patients on ERAS protocols have fewer minor and major complications, and highlight a reduction in medical morbidity (such as urinary and respiratory infections). Limited data is available on surgical complications. The aim of the study was to evaluate the impact of the ERAS protocol on post-operative complications and length of hospital stay. Furthermore, we aimed to determine the impact of this protocol on cost-effectiveness.
Material and Methods: From January 2016 to December 2022, 532 colectomies for colorectal cancer (CRC) were performed. A prospective observational study was conducted in a tertiary hospital on the cohort of patients, aged 18 years and older, operated on for non-urgent colorectal cancer. The impact on post-operative complications, hospital stay and economic impact was analysed in two groups: patients managed under ERAS and non-ERAS protocol. A propensity score-matching analysis was performed between the two groups.
Results: After propensity score matching 1:1, each cohort included 71 patients, and clinicopathological characteristics were well balanced in terms of tumour type, surgical technique and surgical approach. ERAS patients experienced fewer infectious complications and a shorter postoperative stay (p < 0.001). In particular, they had an 8.5% reduction in anastomotic dehiscence (p = 0.012) and surgical wound infections (p = 0.029). After analysis of medical complications, no statistically significant differences were identified in urinary tract infections, pneumonia, gastrointestinal bleeding or sepsis. ERAS protocol was more efficient and cost-effective than the control group, with an overall savings of 37,673.44€.
Conclusions: The implementation of an enhanced recovery protocol for elective colorectal surgery in a tertiary hospital was cost-effective and associated with a reduction in post-operative complications, especially infectious complications.
(© 2024. Springer Nature Switzerland AG.)
Databáze: MEDLINE
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