Financial Effect of Enhanced Recovery After Surgery in Autologous Breast Reconstruction

Enhanced Recovery After Surgery (ERAS) pathways have become increasingly common in surgery, but the ERAS financial impact on autologous breast reconstruction has not been defined.

This study performed a retrospective review of consecutive autologous breast reconstructions (July 2017 to June 2022; 264 patients, 156 pre-ERAS implementation and 108 post-ERAS implementation). Clinical outcomes included length of stay (LOS), ICU length of stay (ICU LOS), average daily morphine milligram equivalent (MME) use, and average total MME use. Financial metrics evaluated the total charges, total cost, direct cost, indirect cost, estimated reimbursement, and direct margin.

Average LOS was lower in the ERAS cohort (2.13 vs. 3.21 days, P < 0.001). Average ICU LOS was lower in the ERAS cohort (0.0 vs 0.75 days, P < 0.001). Total charges were lower in the ERAS cohort ($98,876 vs. $119,568, P < 0.001). Total cost was lower in the ERAS cohort ($25,725 vs. $30,972, P < 0.001). Direct cost was lower in the ERAS cohort ($15,900 vs. $18,823, P < 0.001). Indirect cost was lower in the ERAS cohort ($9825 vs. $12,149, P < 0.001). Estimated reimbursement was equivalent ($27,464 vs. $24,697, P = 0.14). Direct margin was higher in the ERAS cohort ($11,564 vs. $5874, P = 0.0015).

ERAS pathways in autologous breast reconstruction decrease length of stay, ICU utilization, and improve financial metrics. Further investigations into quality improvements in ERAS warrant investigation.