College of Medicine, University of Kentucky, Lexington, USA.
Department of Surgery, Division of General Surgery, University of Kentucky, C 241, Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA.
Surg Endosc. 2020 Sep;34(9):3949-3955. doi: 10.1007/s00464-019-07166-2. Epub 2019 Oct 1.
Open ventral hernia repair (VHR) is associated with postoperative complications and hospital readmissions. A comprehensive Enhanced Recovery after Surgery (ERAS) protocol for VHR contributes to improved clinical outcomes including the rapid return of bowel function and reduced infections. The purpose of this study was to compare hospital costs for patients cared for prior to ERAS implementation with patients cared for with an ERAS protocol.
With IRB approval, clinical characteristics and postoperative outcomes data were obtained via retrospective review of consecutive VHR patients 2 years prior to and 14 months post ERAS implementation. Hospital cost data were obtained from the cost accounting system inclusive of index hospitalization. Clinical data and hospital costs were compared between groups.
Data for 178 patients (127 pre-ERAS, 51 post-ERAS) were analyzed. Preoperative and operative characteristics including gender, ASA class, comorbidities, and BMI were similar between groups. ERAS patients had faster return of bowel function (p = 0.001) and decreased incidence of superficial surgical site infection (p = 0.003). Hospital length of stay did not vary significantly pre and post ERAS implementation. Inpatient pharmacy costs were increased in ERAS group ($2673 vs. $1176 p < 0.001), but total hospital costs (14,692 vs. 15,151, p = 0.538) were similar between groups.
Standardization of hernia care via ERAS protocol improves clinical outcomes without impacting total costs.
开放式腹侧疝修补术（VHR）与术后并发症和医院再入院有关。VHR 的综合增强型术后恢复（ERAS）方案有助于改善临床结果，包括更快地恢复肠道功能和减少感染。本研究的目的是比较在实施 ERAS 前后接受治疗的患者的医院成本。
获得 ERAS 实施前 2 年和实施后 14 个月连续 VHR 患者的临床特征和术后结果数据，经 IRB 批准，通过回顾性研究获得。从包括索引住院在内的成本核算系统中获得医院成本数据。比较组间的临床数据和医院成本。
对 178 例患者（127 例在 ERAS 之前，51 例在 ERAS 之后）的数据进行了分析。术前和手术特征，包括性别、ASA 分级、合并症和 BMI，两组之间相似。ERAS 患者的肠道功能恢复更快（p=0.001），浅表手术部位感染发生率降低（p=0.003）。ERAS 实施前后住院时间无显著差异。ERAS 组住院药房费用增加（$2673 比 $1176，p<0.001），但两组总医院费用（14692 比 15151，p=0.538）相似。
通过 ERAS 方案标准化疝护理可改善临床结果，而不影响总费用。
