Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada

Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. We performed a return on investment (ROI) analysis of the implementation of multiple ERAS gu...

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Bibliographic Details
Published in:Canadian journal of surgery 2020-12, Vol.63 (6), p.E542-E550
Main Authors: Thanh, Nguyen, Nelson, Alison, Wang, Xiaoming, Faris, Peter, Wasylak, Tracy, Gramlich, Leah, Nelson, Gregg
Format: Article
Language:English
Subjects:
Aged
Alberta - epidemiology
Cost Savings - economics
Cost Savings - statistics & numerical data
Economic aspects
Enhanced Recovery After Surgery - standards
Evaluation
Female
Health Plan Implementation - economics
Humans
Length of Stay - economics
Length of Stay - statistics & numerical data
Male
Medical care
Medical care, Cost of
Middle Aged
Patient Acceptance of Health Care - statistics & numerical data
Patient outcomes
Patient Readmission - economics
Patient Readmission - statistics & numerical data
Postoperative care
Postoperative Complications - economics
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative Complications - prevention & control
Practice Guidelines as Topic
Quality management
Surgical Procedures, Operative - adverse effects
Surgical Procedures, Operative - rehabilitation
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Summary:Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars. The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated. These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations.
ISSN:0008-428X
1488-2310
DOI:10.1503/cjs.006720