Requirement for postoperative imaging in an enhanced recovery programme.

Area of Science:

• Colorectal Surgery
• Enhanced Recovery After Surgery (ERAS) Protocols
• Radiology in Postoperative Care

Background:

• Enhanced Recovery After Surgery (ERAS) protocols significantly reduce hospital stay and patient morbidity.
• While the impact of ERAS on nursing and physiotherapy workload is understood, its effect on radiology demand and associated costs remains unclear.
• This study investigates radiology utilization in ERAS patients to identify potential hidden expenditures.

Purpose of the Study:

• To determine the extent of postoperative radiology use in patients undergoing colorectal surgery within an ERAS program.
• To quantify the associated costs of radiology in ERAS patients.
• To inform future cost-effectiveness analyses of ERAS by including radiology expenditures.

Main Methods:

• Retrospective analysis of 265 patients from a prospective ERAS database who underwent colorectal surgery between 2008 and 2009.
• Assessment of all radiology examinations (CT, plain X-ray, ultrasound) performed within 30 days of surgery.
• Evaluation of adverse events, including gut dysfunction, surgical site infection, and reoperation, to correlate with radiology use.

Main Results:

• Postoperative radiology was utilized in 28% of ERAS patients (n=71), with 16% (n=41) undergoing CT of the abdomen and pelvis within 30 days.
• CT scans were required in 13% of patients during their primary admission, including 30% of those with adverse events.
• The estimated radiology cost was over £22,000, averaging £90 per ERAS patient.

Conclusions:

• A significant proportion of ERAS patients require postoperative radiology, often prompted by adverse events.
• Interventional radiology was not required for any patient in this cohort.
• The costs associated with postoperative radiology in ERAS pathways must be incorporated into future economic evaluations.