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Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post-implementation expenditures.

Relph, S.

Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post-implementation expenditures. - 2013

NMUH Staff Publications Epub ahead of print

<div style="line-height: 17.999801635742188px;"><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;"><span class="highlight">Enhanced</span>&nbsp;<span class="highlight">Recovery</span>&nbsp;<span class="highlight">After</span>&nbsp;<span class="highlight">Surgery</span>&nbsp;programmes were first conceived to optimise perioperative patient care and have been delivered by surgical specialities in the UK for over a decade. Although their safety and acceptability have been ratified in many surgical fields including gynaecology and colorectal&nbsp;<span class="highlight">surgery</span>, the&nbsp;<span class="highlight">cost</span>&nbsp;<span class="highlight">effectiveness</span>&nbsp;of its implementation in benign&nbsp;<span class="highlight">vaginal</span>&nbsp;<span class="highlight">surgery</span>&nbsp;remains unclear. In this case-control study, the perioperative expenditure for 45 women undergoing&nbsp;<span class="highlight">vaginal</span>&nbsp;<span class="highlight">hysterectomy</span>&nbsp;at a North London teaching hospital&nbsp;<span class="highlight">after</span>&nbsp;implementation of an&nbsp;<span class="highlight">enhanced</span>&nbsp;<span class="highlight">recovery</span>pathway was compared with 45 matched controls prior to implementation. Frequency of catheter use (84.4% vs. 95.6%) and median length of stay (23.5 vs. 42.9 h) were significantly lower following implementation of pathway (both p &lt; 0.05). Although&nbsp;<span class="highlight">enhanced</span>&nbsp;<span class="highlight">recovery</span>&nbsp;patients were more likely to attend the accident and emergency department for minor symptoms following discharge (15.6% vs. 0%, p &lt; 0.05), the inpatient readmission rate (6.7% vs. 0.0%, p &gt; 0.05) was similar in both groups. Establishing the&nbsp;<span class="highlight">programme</span>&nbsp;incurred additional&nbsp;<span class="highlight">expenditures</span>&nbsp;including delivering a patient-orientated gynaecology 'school' and employing a specialist&nbsp;<span class="highlight">enhanced</span>&nbsp;<span class="highlight">recovery</span>&nbsp;nurse, but despite these, we demonstrated a saving of 15.2% (or 164.86) per patient. The&nbsp;<span class="highlight">cost</span>&nbsp;efficiency savings, coupled with increased satisfaction and no rise in morbidity, offers a very attractive means of managing women undergoing&nbsp;<span class="highlight">vaginal</span>&nbsp;<span class="highlight">hysterectomy</span>. We believe that our data can be reproduced in other centres and recommend that the pathway be used routinely in women undergoing these procedures.&nbsp;</span></p></div>

07496753