Quantification of Cost Savings After Enhanced Recovery Pathway Implementation for Pediatric Colorectal Surgery

BackgroundEnhanced recovery pathways (ERP) have been shown to decrease length of stay and opioid utilization for pediatric patients undergoing colorectal surgery without compromising outcomes. However, the cost benefits of ERP implementation have not been quantified. We sought to describe, for the first time, the resulting fiscal benefits of ERP implementation at a single-center academic hospital, aiming to highlight the financial benefits to hospitals and payers of ERP utilization.MethodsWe conducted a single-institution retrospective cohort study of patients aged 2-18 who underwent planned colorectal surgery before and after our institution implemented a colorectal ERP. Our primary outcome was total hospital admission costs based on hospital length of stay, narcotic use, crystalloid infusion, and multimodal pain medication use. We sourced our cost data from peer-reviewed literature and publicly available cost data. To account for potential confounding, we created a multivariable Gamma regression for cost using the Akaike Information Criterion selection method.ResultsOur retrospective review identified 345 eligible patients who underwent planned colorectal surgery between 2014 and 2024, with a median cost savings of $5689 per case. After adjusting for cofounders and employing our AIC model selection, we found that ERP implementation was associated with an overall 9% reduction in total admission costs compared to patients managed before the ERP (IRR 0.91, 95% CI 0.84-0.99, P = 0.038).ConclusionsThis is the first study to quantify cost savings after ERP implementation for pediatric colorectal surgery, and savings are independently associated with pathway exposure. To determine whether these single-institution savings are generalizable to other children's hospitals a formal additional ERP data from other institutions and a formal cost-effectiveness analysis are needed.