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INTRODUCTION: The aim of this study was to analyze the rate of enhanced recovery programs (ERP) implementation in a range of surgical specialties in both the public and private sectors. METHODS: This was a retrospective longitudinal study based on hospital stays between March to December 2019. We studied thirteen of the activity segments most frequently included in ERP protocol. The procedures selected included digestive, gynecological, orthopedic, thoracic, and urological procedures. The assessment criteria was the rate of ERP. The results were analyzed first overall and then matching ERP stays to non-ERP stays according to type of institution, patient age and sex, month of discharge, and Charlson comorbidity score. RESULTS: We took 420,031 stays into account, of which 78,119 were coded as ERP. There were 62,403 non-ERP stays. Depending on the type of surgery, the implementation rate ranged from 5 percent to 30 percent. The overall rate of ERP implementation was higher in the private sector (21.2 percent) than in the public sector (14.4 percent). The results are reversed for some surgeries, notably for some cancers. Patients had a higher Charlson score in the public sector. CONCLUSIONS: This large-scale national study provides a picture of the degree of diffusion of ERPs in France. Although there are differences between sectors, this diffusion is still insufficient overall. Given the demonstrated benefits of ERPs, more educational efforts are needed to improve their implementation in France.
Assuntos
Recuperação Pós-Cirúrgica Melhorada , Humanos , França , Feminino , Estudos Retrospectivos , Masculino , Estudos Longitudinais , Pessoa de Meia-Idade , Idoso , Adulto , Adulto Jovem , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Study of the medico economic impact of enhanced rehabilitation after surgery (ERAS), by comparing the cost of patient care with or without ERAS, both from the point of view of the hospitals and the Social Security Health Insurance Program. METHODS: Retrospective longitudinal study on matched data from March 1, 2019 to December 31, 2019. The data are extracted from the French prospective payment system. We studied 12 of the most commonly performed in ERAS business segments. The primary outcome was the reduction of the average length of hospital stay and its implications on production costs and excess capacity. We also studied the impact on hospital incomes and Social Security Insurance Program expenses. The potential gain in hospital days was computed by comparing the length of stay of ERAS and non-ERAS cases. The cost reduction was estimated using the mean number of avoidable days of hospitalization, and the mean cost of the stays obtained from the national cost study. Finally, we studied an approximation of the additional expense for the Social Security Health Insurance Program on costs standardized by applying public sector rates. RESULTS: The average length of stay reduction attributed to ERAS is 1.45 (CI 95% 1.42 to 1.48) day per stay, translating to a cost reduction for the hospitals of 1060 (CI 95% 995 to 1125) per patient and a total of 65 million (CI 95% 61 to 69). At the same time, the additional expenses for the Social Security Insurance Program can conservatively be approximated to 1.6 million, breaking into a 2.2 million increase partially compensated by cost savings of 0.6 million over subsequent stays for complications. Overall, for each percent of additional ERAS activity over the scope of the study, the marginal cost reduction for the hospitals can be estimated to 1.8 million (CI 95% 1.7 million to 2.0 million). CONCLUSIONS: Associated with previously known clinical benefits for the patients, these convincing results in terms of economic gain strongly support expanding the adoption of ERAS.
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Hospitais , Redução de Custos , Humanos , Tempo de Internação , Estudos Longitudinais , Estudos RetrospectivosRESUMO
BACKGROUND: Enhanced recovery programs (ERPs) imply early discharge but few papers have assessed the effect of ERPs on post-discharge mortality (PDM). METHODS: A multicenter nationwide case control study based on administrative data was carried out between March and December 2019. Coding for every episode of care whether in the setting of ERP or not is mandatory for hospital funding (public or private). Twelve surgical specialties or procedures were included. The episodes of care coded with ERP were matched with those without ERP code for several factors such as the type of hospital (public or private), age, gender, month of discharge, and updated Charlson score. Ninety-day PDM was the main outcome. RESULTS: Of 420,031 patients in the database, 78,119 had an ERP code. Finally, 132,600 patients with 66,300 matched pairs were considered for the study. Overall, PDM was significantly reduced after ERPs: 0.075% vs 0.138% (p = 0.00042). Significant one-half and two-thirds reduction in PDM was observed respectively after hip arthroplasty (odds ratio 0.48 [95% CI 0.21-0.99]) and colectomy (odds ratio 0.36 [95% CI 0.16-0.74]). CONCLUSION: The findings, based on a large database and a rigorous matching, strongly suggest that ERPs reduce PDM particularly after colectomy and hip arthroplasty. This is likely due to better post-operative care in ERPs.
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The development of day surgery requires the hospital system to be restructured in order for real savings to be made. The hospital must therefore modify its organisational set-up to reap the benefits of the efficiency gains resulting from the development of day surgery.