Benbouzid Amel, Tabchouri Nicolas, Denet Christine, Ferraz Jean-Marc, Laforest Anais, Gayet Brice, Tubbax Candice, Paubel Pascal, d'Avout d'Auerstaedt Ariane, Bossard Anne-Elisabeth, Sarran Anthony, Aminot Isabelle, Camps Sandra, Fuks David
Department of Pharmacy, Institut Mutualiste Montsouris, Paris, France.
Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 boulevard Jourdan, 75014, Paris, France.
Int J Colorectal Dis. 2019 Feb;34(2):301-307. doi: 10.1007/s00384-018-3201-9. Epub 2018 Nov 20.
Despite increasing evidence supporting the beneficial effects of enhanced recovery protocols (ERPs), their accurate economic impact on institutions remains lacking. The aim of this study was to analyze ERP economic impact in a French center in order to further encourage implementation.
All patients who underwent elective laparoscopic right or left colectomy for benign or malignant pathology from 2014 to 2017 in a single center were retrospectively reviewed. ERP according to national recommendations was effective starting November 2015. Perioperative data and all direct costs borne by the institution were collected for each patient. Patients who underwent colectomy before and after ERP implementation were compared.
Overall, 288 patients were included of which 144 received conventional perioperative care (CC) and 144 received ERP. There were 161 (56%) men, median age was 71 (28-92) years, and 242 (84%) patients underwent surgery for malignant disease. Operative time, intraoperative blood loss, and severe postoperative complications were similar between both groups. ERP was associated with reduced Clavien-Dindo I-II postoperative complications (15% vs. 28%, p = 0.010) and overall in-hospital stay (6 vs. 7 days, p = 0.003). Overall institutional costs were lower in the ERP group although difference was not statistically significant (7022 vs. 7501 euros, p = 0.098). Estimated savings per patient reached a mean of 480 euros.
In a tertiary French center, ERP was associated with reduced postoperative morbidity and in-hospital stay resulting in considerable cost savings. Although not significant, ERP resulted in positive economic impact even in an early implementation phase.
尽管越来越多的证据支持强化康复方案（ERP）的有益效果，但其对医疗机构的确切经济影响仍不明确。本研究旨在分析法国一家中心的ERP经济影响，以进一步鼓励其实施。
回顾性分析2014年至2017年在单一中心因良性或恶性病变接受择期腹腔镜右半或左半结肠切除术的所有患者。根据国家建议，ERP自2015年11月起生效。收集每位患者的围手术期数据及机构承担的所有直接费用。比较ERP实施前后接受结肠切除术的患者。
共纳入288例患者，其中144例接受传统围手术期护理（CC），144例接受ERP。男性161例（56%），中位年龄71岁（28 - 92岁），242例（84%）患者因恶性疾病接受手术。两组间手术时间、术中出血量及严重术后并发症相似。ERP与Clavien-Dindo I-II级术后并发症减少相关（15%对28%，p = 0.010）及总体住院时间缩短相关（6天对7天，p = 0.003）。尽管差异无统计学意义（7022对7501欧元，p = 0.098），但ERP组的总体机构成本较低。每位患者估计节省平均达480欧元。
在法国一家三级中心，ERP与术后发病率降低和住院时间缩短相关，从而节省了大量成本。尽管不显著，但即使在早期实施阶段，ERP也产生了积极的经济影响。
