費用節約に関連する要素は？：術後回復強化プログラムの遵守について

Enhanced Recovery Programs (ERP) are standardized, evidence-based surgical care pathways consisting of pre, intra, and postoperative components. While high adherence to these components improves surgical outcomes and reduces costs, which components contribute most to cost remains unclear. Therefore, we aimed to identify which ERP components are associated with cost-saving to better guide implementation strategies.

A single-center retrospective cohort study was conducted through patients receiving ERP for colorectal operation from 2021-2023. Data was obtained from our institution's ERP, financial, and medical records. A 1:1 propensity-matched analysis was conducted on patients with high (≥70%) vs. low adherence (<70%) to sixteen ERP components based on age, sex, race, insurance status, procedure type, and operative approach. Statistical tests performed were Kruskal-Wallis and Chi-square tests.

Of 334 patients evaluated, 41.3% were >65 years old, 54.2% were female, 47.3% had Medicare, 37.7% had extended colectomy, and 48.5% had robotic operation. Patients in the high adherence group had lower total cost ($17,576 vs $22,343, p<0.001). Associations to cost-saving were identified in adherence to preoperative clear liquid diet (-$1,727), no nasogastric tube (NGT; -$16,036), early mobilization (-$3,476), early diet (-$1,572), maintenance intravenous fluid (IVF; -$4,460) discontinuation, and early Foley removal ($-4,274; all p<0.05). When stratified by 70% overall adherence, adherence to no NGT, early mobilization, and maintenance IVF discontinuation consistently lowered costs in both groups (p<0.05).

Adherence to ERP components is associated with cost-saving. Future targeted interventions to reach 70% adherence and maximize adherence to crucial components are essential to reduce costs.