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Costs of QI Program for Colorectal Surgery Offset by Savings

BALTIMORE – Putting into place a new quality improvement program to speed recovery of colorectal surgery patients might come at a cost, but those expenses are more than offset by the savings, according to an “article in press” from the Journal of the American College of Surgeons.

Study authors, led by Johns Hopkins Medical Institutions researchers, conceded that the patient-centric program requires significant upfront investments in patient educational materials, dedicated time for frontline providers to develop and implement the pathway, and to develop a framework for measuring their performance.

The researchers argue, however, that the programs can save money for hospitals of various sizes and volumes of colorectal surgery.

For the analysis, the study team evaluated the lengths of stay and costs documented in six published reports of Enhanced Recovery After Surgery (ERAS) programs that were implemented in U.S. hospitals for patients undergoing colorectal procedures between 2003 and 2015. Data from those reports were then used to generate a financial model reflecting the net financial effect of implementing ERAS.

Included in the data were implementation costs, reductions in length of stay, and the per-day reductions in direct variable costs associated with shorter hospital stays, as well as annual surgical caseload.

Key elements of ERAS programs, which create evidence-based protocols that promote the adoption of a standardized approach to perioperative care, include counseling about expectations for the procedure and hospitalization for patients and their families, optimizing preoperative and postoperative nutrition, minimizing the use of narcotic pain management, and promoting early mobility after surgery.

The result, according to the previous studies, has been reduced complications, hospital stays, and costs, as well as improved patient experience.

“With the model described in this study, surgeons can plug in their case volumes and current length of stay and cost metrics and determine the potential cost savings, based on published U.S. studies, they might expect at their hospital,” said lead study author Elizabeth Wick, MD, FACS, in an American College of Surgeons press release. “The model gives surgeons a framework for having a sophisticated discussion about how to initiate these types of programs with hospital administrators and what type of return on investment can be anticipated.”

For example, hospitals with an assumed annual number of 100 colorectal procedures would have $117,875 in costs for implementation of ERAS in the first year and $107,875 in annual maintenance costs, compared to $552,783 initially and $356,944 annually thereafter for a large colorectal surgery program performing 500 procedures a year.

Study authors suggest that the costs are more than offset by net savings. At The Johns Hopkins Hospital, they write, ERAS protocols reduced length of stay on average by 1.9 days (26.4%) and direct variable costs by $1,897 per patient. With an annual caseload of 500 patients, ERAS protocols yielded a total cost savings of $948,500, according to the study, which translated into net annual savings of $395,717.

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