Cost analysis of enhanced recovery after surgery in microvascular breast reconstruction

Publication date: Available online 2 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Christine Oh, James Moriarty, Bijan J. Borah, Kristin C. Mara, William S. Harmsen, Michel Saint-Cyr, Valerie Lemaine
BackgroundEnhanced recovery after surgery (ERAS) pathways has been shown in multiple surgical speciaalties to decrease hospital length of stay (LOS) after surgery. ERAS in breast reconstruction has been found to decrease hospital length of stay and inpatient opioid use. ERAS protocols can facilitate a patient's recovery and is a systemwide improvement that can potentially increase the quality of care while decreasing costs.MethodsA standardized ERAS pathway was developed through multidisciplinary collaboration. It addressed all phases of surgical care for patients undergoing free-flap breast reconstruction utilizing an abdominal donor site. In this retrospective cohort study, clinical variables associated with hospitalization costs for patients who underwent free-flap breast reconstruction with the ERAS pathway were compared with those of historical controls, termed traditional recovery after surgery (TRAS). All patients included in the study underwent surgery between September 2010 and September 2014. Predicted costs of the study groups were compared using generalized linear modeling.ResultsA total of 200 patients were analyzed: 82 in the ERAS cohort and 118 in the TRAS cohort. Clinical variables found to have a statistically significant difference between groups that affected costs included unilateral versus bilateral procedure (p=0.04) and need for postoperative blood transfusion (p=0.03). The cost regression analysis on the two cohorts adjusted for these significant variables. Adjusted mean costs of ERAS patients were found to be $4,576 less than the TRAS control group ($38,688 versus $43,264).ConclusionsImplementation of the ERAS pathway was associated with significantly decreased costs when compared to historical controls. There has been a healthcare focus towards prudent resource allocation that dictates the need for plastic surgeons to recognize economic evaluation of clinical practice. The ERAS pathway can increase health care accountability by improving quality of care while simultaneously decreasing the costs associated with autologous breast reconstruction.