Ackerman Robert S, Hirschi Michael, Alford Brandon, Evans Trip, Kiluk John V, Patel Sephalie Y
Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs, Tampa, FL, 33612, USA.
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
World J Surg. 2019 Mar;43(3):839-845. doi: 10.1007/s00268-018-4850-0.
Enhanced recovery after surgery (ERAS) protocols have been shown to improve surgical, anesthetic, and economic outcomes in intermediate-to-high-risk surgeries. Its influence on length of stay and cost of low-risk surgeries has yet to be robustly studied. As value-based patient care comes to the forefront of anesthesiology research, the focus shifts to strategies that maintain quality while effectively containing cost.
In July 2016, we implemented an ERAS for mastectomy protocol consisting of limiting fasting state, preoperative multimodal analgesia, and pectoralis I and II blocks. After 1 year, patient records were retrospectively reviewed for length of stay, opioid consumption, pain scores, and hospital charges.
Implementation of an ERAS protocol for mastectomies led to a decrease in opioid consumption, and statistically significant decrease in length of stay (1.19 vs. 1.44, p = 0.01). No significant change in hospital charges was observed ($25,787 vs. $25,863, p = 0.97); however, the variance of charges was significantly decreased (6.8 × 10 vs. 1.5 × 10, p = 0.002). The decrease in length of stay translated to an extra 100 hospital bed days which can provide up to an additional $2,100,000 in gross patient service revenue from additional mastectomy volume.
ERAS protocols for mastectomies may prove beneficial by allowing growing hospitals to increase bed capacity and consequently surgical volume. Despite no change in hospital charges, we predict a potential increase in gross patient service revenue of $2.1 million due to saved hospital bed days.
手术加速康复（ERAS）方案已被证明可改善中高风险手术的手术、麻醉和经济结局。其对低风险手术住院时间和费用的影响尚未得到充分研究。随着基于价值的患者护理成为麻醉学研究的前沿，重点转向在有效控制成本的同时保持质量的策略。
2016年7月，我们实施了一项用于乳房切除术的ERAS方案，包括限制禁食状态、术前多模式镇痛以及胸大肌和胸小肌阻滞。1年后，对患者记录进行回顾性审查，以了解住院时间、阿片类药物消耗量、疼痛评分和医院收费情况。
实施乳房切除术的ERAS方案导致阿片类药物消耗量减少，住院时间有统计学意义的缩短（1.19天对1.44天，p = 0.01）。未观察到医院收费有显著变化（25,787美元对25,863美元，p = 0.97）；然而，收费的方差显著降低（6.8×10对1.5×10，p = 0.002）。住院时间的缩短转化为额外的100个医院床位日，这可以通过增加乳房切除术数量为患者服务总收入额外带来高达210万美元的收入。
乳房切除术的ERAS方案可能通过使不断发展的医院增加床位容量从而增加手术量而证明是有益的。尽管医院收费没有变化，但我们预计由于节省的医院床位日，患者服务总收入可能会增加210万美元。
