Cost-analysis of Enhanced Recovery After Surgery (ERAS) program in gynecologic surgery

Enhanced recovery after surgery (ERAS) programs has shown clinical benefits in gynecologic surgery. The aim of the present study was to compare costs before and after implementation of an ERAS program for gynecologic surgery. Retrospective study comparing perioperative costs between consecutive patient groups undergoing gynecologic surgery (benign, staging or debulking) (I, 2012-13) prior, (II) immediately after, and (III, 2014-16) the three years after ERAS implementation. Preoperative, intraoperative, and postoperative real costs were collected for each patient via hospital administration. A bootstrap independent t-test was used for comparison. Demographics and preoperative characteristics were similar between group I (n = 42), II (n = 51), and III (ERAS I; n = 122, II; n = 134, III; n = 90). Average ERAS-specific costs were $687 per patient. Total mean individual costs per patient were $13′329 (95% confidence interval (CI): 11’301-15’213) and $17’710 (95% CI: 14′452–21′605) in the ERAS and pre-ERAS groups respectively, resulting in net savings of $4′381 (95% CI: 549–8’752, p = 0.043) in favour of ERAS group. Cost savings were explained by lower pre- and postoperative costs (difference: $5’011 95% CI: 1’587–8’998, p = 0.019). Total costs continued to decrease by $2′520 (mean: $15’190, 95% CI: 13’791–16’631) in year 1, by $3’077 (mean: $14’633, 95% CI: 13’378–16’250) and $5’070 (mean: $12’640, 95% CI: 11’460–14’015) (p = 0.03) respectively, in year 2 and 3 after implementation. Based on real costs and including specific costs due to ERAS implementation, ERAS program in gynecologic surgery induced significant decrease of overall costs by $4’381 per patient. Total costs continued to decrease in the three years after implementation. •Total cost saving during implementation period was $1’498’302.•ERAS implementation in gynecology is cost-effective.•ERAS remains cost-effective after implementation.