Conventional versus enhanced recovery laparoscopic cholecystectomy in Rwanda: A comparative analysis of costs and...

Enhanced Recovery After Surgery (ERAS) protocols improve outcomes in high-income settings, but evidence from low- and middle-income countries (LMICs) is limited. This study compared clinical outcomes and direct healthcare costs between conventional laparoscopic cholecystectomy (CLC) and ERAS-based laparoscopic cholecystectomy (ERAS-LC) in Rwanda.

A prospective before-after cohort study was conducted between January and December 2022 at two tertiary hospitals in Rwanda. A total of 124 adult patients undergoing elective laparoscopic cholecystectomy were included: 70 managed with conventional care and 54 within an ERAS pathway. Clinical outcomes (length of stay, opioid use, time to oral intake, complications) and direct hospital costs were compared. Statistical analyses included chi-square, t-tests, Mann-Whitney U tests, and multivariable regression models adjusting for potential confounders.

Groups were similar at baseline. All ERAS patients resumed oral intake on day one versus 87.1% in CLC (p = 0.006); delayed feeding occurred only in CLC (12.9%). Mean LOS was shorter with ERAS (1.2 ± 0.4 vs. 4.2 ± 1.1 days; p < 0.001), a >70% reduction. Opioid use was lower in ERAS (25.8% vs. 50.0%; p = 0.012) without increased complications. Nursing costs decreased significantly (p < 0.001), while medication and surgical act costs were higher, redistributing overall expenses.

ERAS for laparoscopic cholecystectomy in a resource-limited setting is feasible, safe, and improves recovery while optimizing inpatient resource use. Despite higher medication costs, ERAS reduces LOS, opioid use, and nursing costs, supporting its adoption in LMIC surgical care.