Departments of Anesthesiology.
Public Health Sciences, University of Virginia, Charlottesville, VA.
J Neurosurg Anesthesiol. 2023 Apr 1;35(2):187-193. doi: 10.1097/ANA.0000000000000827. Epub 2021 Dec 15.
Enhanced recovery after spine surgery (ERAS) is increasingly utilized to improve postoperative outcomes and reduce cost. There are limited data on the monetary benefits of ERAS when incorporating the costs of developing, operationalizing, and maintaining ERAS programs. The objective of this study was to calculate the incremental cost-effectiveness of a spine surgery ERAS program, modeling hospital and operational cost and length of stay (LOS).
The study included adult patients undergoing spine surgery before and after implementation of an ERAS program. Variables included individual patient-level and ERAS personnel costs, with LOS as the outcome utility of interest. Propensity score matching was used to create a quasi-experimental design to equate the standard care and ERAS groups.
Four hundred and nine patients were included in the unmatched group, with 54 patients each in the standard care and ERAS groups after matching. In the matched cohort, the only imbalance in predictors (standard mean difference [SMD] >0.2) were race (SMD, 0.21), American Society of Anesthesiologist (ASA) physical status (SMD, 0.32), fluid balance in the operating room (SMD, 0.21), median (interquartile range) LOS (standard care, 2.0 [1.0, 3.75] days vs. ERAS, 4.0 [3.0, 5.0]; SMD, 0.81) and mean (±SD) total cost (standard care, $19,291.57±13,572.24 vs. ERAS, $24,363.45±26,352.45; SMD, 0.24). In the incremental cost effectiveness analysis, standard care was the dominant strategy in both 1-way and 2-way sensitivity analysis.
We report a real-world, cost-effectiveness analysis following implementation of an ERAS program for spine surgery at a quaternary medical center. Our study demonstrated that considering LOS as the sole determinant, standard care is the dominant cost-effective strategy compared with the ERAS protocol.
加速康复外科（ERAS）越来越多地被用于改善术后结果并降低成本。但是，将开发、实施和维持 ERAS 计划的成本纳入其中时，关于 ERAS 的货币收益的数据有限。本研究的目的是计算脊柱手术 ERAS 计划的增量成本效益，对医院和运营成本以及住院时间（LOS）进行建模。
该研究纳入了在实施 ERAS 计划前后接受脊柱手术的成年患者。变量包括患者个体层面和 ERAS 人员成本，以 LOS 作为感兴趣的结果效用。采用倾向评分匹配创建准实验设计，以使标准护理组和 ERAS 组相匹配。
共有 409 例患者纳入未匹配组，匹配后标准护理组和 ERAS 组各有 54 例患者。在匹配队列中，唯一不平衡的预测因子（标准均数差 [SMD]＞0.2）是种族（SMD，0.21）、美国麻醉医师协会（ASA）身体状况（SMD，0.32）、手术室中的液体平衡（SMD，0.21）、中位数（四分位间距） LOS（标准护理，2.0[1.0，3.75]天 vs. ERAS，4.0[3.0，5.0]天；SMD，0.81）和平均（±SD）总费用（标准护理，19291.57±13572.24 美元 vs. ERAS，24363.45±26352.45 美元；SMD，0.24）。在增量成本效益分析中，在单向和双向敏感性分析中，标准护理都是主导策略。
我们报告了在一家四级医疗中心实施脊柱手术 ERAS 方案后的真实世界成本效益分析。我们的研究表明，仅考虑 LOS 作为唯一决定因素时，与 ERAS 方案相比，标准护理是更具成本效益的主导策略。
