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Enhanced Recovery Program Adherence: Which Components are Associated with Cost Saving?

Alfonsus Adrian H Harsono1, Lauren Wood1, Gianina C Hernandez-Marquez1

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Enhanced Recovery Programs (ERP) significantly reduce costs, particularly through avoiding nasogastric tubes and early patient mobilization. Focusing on these key ERP components can optimize cost savings in surgical care.

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Area of Science:

  • Surgical Care Pathways
  • Health Economics
  • Evidence-Based Medicine

Background:

  • Enhanced Recovery Programs (ERP) are evidence-based protocols for surgical care.
  • While ERPs improve outcomes and reduce costs, the specific components driving cost savings are not well-defined.
  • Identifying cost-saving ERP components can refine implementation strategies.

Purpose of the Study:

  • To identify which components of Enhanced Recovery Programs (ERP) are associated with significant cost savings.
  • To guide future implementation strategies for ERPs.

Main Methods:

  • A retrospective cohort study of 334 colorectal surgery patients undergoing ERP from 2021-2023.
  • A 1:1 propensity-matched analysis compared high (≥70%) vs. low (<70%) adherence to 16 ERP components.
  • Data analyzed from institutional ERP, financial, and medical records.

Main Results:

  • High ERP adherence patients had lower total costs ($17,576 vs $22,343).
  • Cost-saving components included: no nasogastric tube (NGT), early mobilization, early diet, maintenance intravenous fluid (IVF) discontinuation, and early Foley removal.
  • No NGT, early mobilization, and maintenance IVF discontinuation consistently reduced costs across adherence levels.

Conclusions:

  • Adherence to specific Enhanced Recovery Program (ERP) components is directly linked to cost savings.
  • Targeted interventions focusing on high-impact components like avoiding NGTs and promoting early mobilization are crucial for maximizing cost reduction.
  • Achieving 70% overall adherence and prioritizing key components can enhance financial benefits of ERPs.