Chipollini Juan, Tang Dominic H, Hussein Karim, Patel Sephalie Y, Garcia-Getting Rosemarie E, Pow-Sang Julio M, Gilbert Scott M, Sexton Wade J, Spiess Philippe E, Poch Michael A
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
Morsani College of Medicine, University of South Florida, Tampa, FL.
Urology. 2017 Jul;105:108-112. doi: 10.1016/j.urology.2017.03.023. Epub 2017 Mar 23.
To compare perioperative charges induced at the initial phase of a standardized enhanced recovery after surgery (ERAS) program from a tertiary referral center.
A multidisciplinary ERAS protocol was implemented in our department on July 2015. During the subsequent year, all patients were treated according to this protocol (ERAS group). The patients were compared in terms of real in-hospital charges per surgical episode with a control group consisting of consecutive patients before the start of ERAS. Individual charges were analyzed per sample population and compared with the Wilcoxon rank-sum test or t test. Additionally, cost variances for each group were evaluated.
A total of 257 consecutive patients were evaluated of which the last 112 were ERAS patients. The median length of stay for each group was 6 days (P = .748). ERAS patients incurred higher medication charges ($1939 vs $1729, P = .036). Control patients incurred higher supplies ($861 vs $692), treatment ($90 vs $72), and miscellaneous charges ($537 vs $388) (all, P < .001). The median total charges per patient were $59,539 for the control group and $60,655 for the ERAS group (P = .175). ERAS adoption significantly reduced variance in billed charges (P < .001).
ERAS implementation did not significantly increase expenditure for cystectomy patients. ERAS showed decreased variance in charges likely due to standardization of care while eliciting savings in supplies, treatment, and miscellaneous costs.
比较来自一家三级转诊中心的标准化术后加速康复（ERAS）项目初始阶段的围手术期费用。
2015年7月在我科实施了多学科ERAS方案。在随后的一年里，所有患者均按照该方案进行治疗（ERAS组）。将这些患者与ERAS开始前由连续患者组成的对照组进行每次手术的实际住院费用比较。对每个样本群体的个体费用进行分析，并与Wilcoxon秩和检验或t检验进行比较。此外，还评估了每组的成本差异。
共评估了257例连续患者，其中最后112例为ERAS患者。每组的中位住院时间均为6天（P = 0.748）。ERAS患者的药品费用较高（1939美元对1729美元，P = 0.036）。对照组患者的耗材费用（861美元对692美元）、治疗费用（90美元对72美元）和杂项费用（537美元对388美元）较高（均P < 0.001）。对照组患者的人均总费用中位数为59,539美元，ERAS组为60,655美元（P = 0.175）。采用ERAS显著降低了计费费用的差异（P < 0.001）。
ERAS的实施并未显著增加膀胱切除术患者的费用。ERAS显示费用差异减少，这可能是由于护理标准化，同时在耗材、治疗和杂项成本方面实现了节约。
