Login to Access Video or Poster Abstract: MP32-16
Sources of Funding: none

Introduction

Although an increasing body of evidence for patients undergoing radical cystectomy (RC) supports the clinical effectiveness of enhanced recovery after surgery (ERAS) programs, there is little literature regarding its cost benefit for RC. The present study aim was to analyze the implementation costs of ERAS for RC program at a tertiary, referral center.

Methods

A dedicated ERAS protocol was implemented in our department in July 2015. The subsequent year all consecutive patients were treated according to this protocol (ERAS group). They were compared in terms of real in-hospital charges per surgical episode with a separate pre-ERAS cohort. Mean costs per patient were compared with Wilcoxon-rank sum test and t-test, with p-value < 0.05 considered statistically significant.

Results

A total of 257 consecutive patients were evaluated of which 112 were ERAS patients. The median age was 70 years with no difference between the groups (p = 0.13). Median length of stay was 6 days (p = 0.748). Table 1 lists itemized in-hospital charges. The mean total charges per patient were $63,364 vs. 65,151 in the ERAS vs. pre-ERAS groups, respectively (p = 0.412). The variances between the two groups were statistically significantly different (p < 0.001). ERAS patients incurred higher medication costs ($3,505 vs. 2,796, p = 0.013). Pre-ERAS patients incurred higher supplies, treatment and miscellaneous charges (all, p < 0.05). Only 11 ERAS patients required intensive care vs. 31 pre-ERAS (p = 0.017) with no difference in cost per patient (p= 0.101).

Conclusions

Fewer patients in the ERAS group required intensive care. ERAS implementation did not increase overall health costs for cystectomy patients when compared to standard care. The ERAS group showed a decrease in cost variance likely due to standardization of care. ERAS elicited savings in supplies, treatment and miscellaneous costs.

Funding

none