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Updated: Feb 26, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Cost Analysis of the Enhanced Recovery After Surgery Protocol in Patients Undergoing Radical Cystectomy for Bladder
Jamal Nabhani1, Hamed Ahmadi1, Anne K Schuckman1
1University of Southern California (USC) Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
Background:
Enhanced recovery after surgery (ERAS) protocols for radical cystectomy (RC) aim to improve patient care, reduce complications, and shorten hospital stay while potentially reducing health care expenditure.
Objective:
Evaluate the ERAS protocol for 30-d global costs relative to standard management in the era immediately preceding the initiation of ERAS for RC.
Design, Setting, And Participants:
Overall, 201 consecutive patients (99 with standard management, 102 with an ERAS protocol) who met inclusion criteria and who underwent open RC at a single institution were evaluated. Resource-based costs were collected for the initial surgical admission and for any readmissions or unscheduled clinic visits within 30 d.
Intervention:
Implementation of the ERAS protocol.
Outcome Measurements And Statistical Analysis:
Line-item billing data were transformed using resource-based cost estimates. Tukey-Kramer least squares mean analysis was performed to adjust for cost differences attributable to patient characteristics on multivariate analysis (age <70 yr, male sex, and Charlson comorbidity score 0-1). Adjusted overall costs for the standard and ERAS cohorts were calculated with each line item assigned to 1 of 10 cost centers to identify specific areas of savings or increased expenditures with implementation of ERAS.
Results And Limitations:
Average 30-d costs were $31 139 with standard management and $26 650 after implementation of ERAS, for savings of $4488 per procedure (p<0.0001). Areas of significant ERAS savings included intensive care unit care ($2056), surgical ward costs ($2029), ancillary treatment ($1279), and supplies ($1238), whereas increased ERAS expenditures included costs for drugs ($2088), home health ($590), and unscheduled outpatient visits ($162). Surgical/anesthesia costs were similar between the standard and ERAS groups at $6405 and $6286 respectively. This was a single-institution study.
Conclusions:
In addition to clinical benefits, ERAS for RC at our institution also afforded an average cost savings of $4488 per procedure.
Patient Summary:
In this report, we evaluated the cost center-specific expenditures of the ERAS protocol for RC, demonstrating $4488 savings in 30-d costs relative to standard management.
