From morbidity reduction to cost-effectiveness: Enhanced recovery after surgery (ERAS) society recommendations in minimal invasive liver surgery.
Langenbecks Arch Surg
; 409(1): 137, 2024 Apr 23.
Article
em En
| MEDLINE
| ID: mdl-38653917
ABSTRACT
PURPOSE:
Minimal-invasive liver surgery (MILS) reduces surgical trauma and is associated with fewer postoperative complications. To amplify these benefits, perioperative multimodal concepts like Enhanced Recovery after Surgery (ERAS), can play a crucial role. We aimed to evaluate the cost-effectiveness for MILS in an ERAS program, considering the necessary additional workforce and associated expenses.METHODS:
A prospective observational study comparing surgical approach in patients within an ERAS program compared to standard care from 2018-2022 at the Charité - Universitätsmedizin Berlin. Cost data were provided by the medical controlling office. ERAS items were applied according to the ERAS society recommendations.RESULTS:
537 patients underwent liver surgery (46% laparoscopic, 26% robotic assisted, 28% open surgery) and 487 were managed by the ERAS protocol. Implementation of ERAS reduced overall postoperative complications in the MILS group (18% vs. 32%, p = 0.048). Complications greater than Clavien-Dindo grade II incurred the highest costs ( 31,093) compared to minor ( 17,510) and no complications (13,893; p < 0.001). In the event of major complications, profit margins were reduced by a median of 6,640.CONCLUSIONS:
Embracing the ERAS society recommendations in liver surgery leads to a significant reduction of complications. This outcome justifies the higher cost associated with a well-structured ERAS protocol, as it effectively offsets the expenses of complications.Palavras-chave
Texto completo:
1
Temas:
ECOS
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Aspectos_gerais
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Análise Custo-Benefício
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Procedimentos Cirúrgicos Minimamente Invasivos
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Recuperação Pós-Cirúrgica Melhorada
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Hepatectomia
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Langenbecks Arch Surg
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Alemanha