Cost Saving Analysis of an Enhanced Recovery After Surgery (ERAS) Program for Elective Colorectal Surgery in an ERAS Qualified and Training Center

To ascertain the costs of implementing an enhanced recovery after surgery (ERAS) protocol in elective colorectal surgery throughout all perioperative phases in an Italian ERAS Qualified and Training Center.

Consecutive patients who had undergone elective colorectal surgery in 2022, the first year of our facility being an ERAS Qualified Center (n 204; ERAS group), were compared to a control group (n 203; pre-ERAS group) that had undergone elective colorectal surgery in 2017, the last year before the internal ERAS implementation. The primary endpoint was the cost-effectiveness of the ERAS protocol as determined by evaluating perioperative costs. Secondary endpoints were postoperative clinical outcomes.

In the ERAS group, fewer postoperative complications (p < 0.001), a shorter length of stay (LOS) (p < 0.001), and a decreased 30-day readmission rate (p 0.047) were reported. The mean cost saving for elective colorectal surgery in the ERAS setting was about €3676.73 per patient. The preoperative costs in the ERAS group were 45% higher than in the control group. The intraoperative phase showed a small but significant decrease in costs (-€324.04, SD 1683.81, and p 0.002). The postoperative phase also had a significant decrease in costs (-€3439.30, SD 6903.07, and p < 0.001), which was especially apparent in patients with severe complications.

Despite significantly increased costs in the preoperative phase, the ERAS protocol, when highly complied with, may lead to significantly decreased patient pathway costs due to a reduction of postoperative complications, a shorter LOS, and the more targeted use of medication and blood transfusions.