Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany.
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
BMC Health Serv Res. 2021 Mar 20;21(1):254. doi: 10.1186/s12913-021-06218-5.
ERAS (Enhanced Recovery After Surgery) is a multidisciplinary and integrative approach with the goal of optimizing the postoperative recovery. We aimed to analyze the economic impact of a newly established ERAS protocol in minimally invasive heart valve surgery at our institution.
ERAS protocol was implemented in 61 consecutive patients who were referred for elective minimally-invasive aortic or mitral valve surgery, between February 1, 2018 and March 31, 2019 (ERAS-group). Another 69 patients who underwent elective minimally-invasive heart valve surgery during the same time period were managed according to the hospital standards (Control-group). A detailed cost comparison analysis was carried out from a hospital perspective using a micro-costing approach.
The total in-hospital stay was significantly shorter in the ERAS-group compared to the Control-group (6.1 ± 2.6 vs 7.7 ± 3.8 days; p = 0.008) resulting in significant cost savings of €1087.2 per patient (p = 0.003). Due to the intensified physiotherapy in the ERAS protocol, the costs for physiotherapy were €94.3 higher compared to the Control-group (p < 0.001). The total costs in the ERAS cohort were €11,200.0 ± 3029.6/patient compared to € 13,109.8 ± 4527.5/patient in the Control-Group resulting in cost savings of €1909.8 patient due to the implementation of the ERAS protocol (p = 0.006).
Implementation of an ERAS-protocol in minimally-invasive cardiac surgery can be carried out safely with a fast postoperative recovery of the patient. ERAS results in a financial benefit of up to €1909 per patient and therefore will play a key role in modern cardiac surgery in the near future.
ERAS（术后加速康复）是一种多学科和综合的方法，旨在优化术后恢复。我们旨在分析我院微创心脏瓣膜手术中一个新建立的 ERAS 方案的经济影响。
2018 年 2 月 1 日至 2019 年 3 月 31 日期间，我们对 61 例择期微创主动脉瓣或二尖瓣手术患者实施 ERAS 方案（ERAS 组）。在此期间，根据医院标准对另外 69 例接受择期微创心脏瓣膜手术的患者进行管理（对照组）。从医院角度出发，采用微观成本法进行详细的成本比较分析。
ERAS 组的总住院时间明显短于对照组（6.1±2.6 天 vs 7.7±3.8 天；p=0.008），每位患者的成本节约为 1087.2 欧元（p=0.003）。由于 ERAS 方案中强化了物理治疗，ERAS 组的物理治疗费用比对照组高出 94.3 欧元（p<0.001）。ERAS 组的总费用为 11200.0±3029.6 欧元/例，对照组为 13109.8±4527.5 欧元/例，由于实施 ERAS 方案，每位患者可节省 1909.8 欧元（p=0.006）。
在微创心脏手术中实施 ERAS 方案可以安全进行，患者术后恢复迅速。ERAS 可使每位患者获得高达 1909 欧元的经济效益，因此在不久的将来将在现代心脏手术中发挥关键作用。
